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. 2023 Jun 15:10:1188501.
doi: 10.3389/fcvm.2023.1188501. eCollection 2023.

Single-center initial experience with inner-branch complex EVAR in 44 patients

Marvin Kapalla  1 , Albert Busch  1 , Brigitta Lutz  1 , Heiner Nebelung  2 , Steffen Wolk  1 , Christian Reeps  1
Affiliations

Single-center initial experience with inner-branch complex EVAR in 44 patients

Marvin Kapalla et al. Front Cardiovasc Med. .

Abstract

Purpose: The use of inner-branch aortic stent grafts in the treatment of complex aortic pathologies aims at broad applicability and stable bridging stent sealing compared to other endovascular technologies. The objective of this study was to evaluate the early outcomes with a single manufacturer custom-made and off-the-shelf inner-branched endograft in a mixed patient cohort.

Methods: This retrospective, monocentric study between 2019 and 2022 included 44 patients treated with inner-branched aortic stent grafts (iBEVAR) as custom-made device (CMD) or off-the-shelf device (E-nside) with at least four inner branches. The primary endpoints were technical and clinical success.

Results: Overall, 77% (n = 34) and 23% (n = 10) of the patients (mean age 77 ± 6.5 years, n = 36 male) were treated with a custom-made iBEVAR with at least four inner branches and an off-the-shelf graft, respectively. Treatment indications were thoracoabdominal pathologies in 52.2% (n = 23), complex abdominal aneurysms in 25% (n = 11), and type Ia endoleaks in 22.7% (n = 10). Preoperative spinal catheter placement was performed in 27% (n = 12) of patients. Implantation was entirely percutaneous in 75% (n = 33). Technical success was 100%. Target vessel success manifested at 99% (178/180). There was no in-hospital mortality. Permanent paraplegia developed in 6.8% (n = 3) of patients. The mean follow-up was 12 months (range 0-52 months). Three late deaths (6.8%) occurred, one related to an aortic graft infection. Kaplan-Meier estimated 1-year survival manifested at 95% and branch patency at 98% (177/180). Re-intervention was necessary for a total of six patients (13.6%).

Conclusions: Inner-branch aortic stent grafts provide a feasible option for the treatment of complex aortic pathologies, both elective (custom-made) and urgent (off-the-shelf). The technical success rate is high with acceptable short-term outcomes and moderate re-intervention rates comparable to existing platforms. Further follow-up will evaluate long-term outcomes.

Keywords: aortic stent graft; complex endovascular aortic repair; inner branches; off-the-shelf; thoracoabdominal aneurysm repair.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Sketches of FEVAR, BEVAR, and iBEVAR. Left: BEVAR (outer branches). Middle: FEVAR (fenestrations). Right: iBEVAR (inner branches).
Figure 2
Figure 2
Intraoperative imaging. Left: stent graft depicted before deployment in fluoroscopy (circle: E-markers for orientation). Middle: cannulation of AMS-branch using a steerable sheath with bridging stent in position (*branch inlet marker; +branch outlet marker). Right: final angiography.
Figure 3
Figure 3
Pre- and postoperative CTA in 3D volume rendering technique. Left: preoperative TAAA type II. Right: postoperative after iBEVAR. CTA, computed tomography angiography; TAAA, thoracoabdominal aortic aneurysm.
Figure 4
Figure 4
Kaplan–Meier estimates of overall survival and overall patency.
Figure 5
Figure 5
Kaplan–Meier estimates for freedom from re-intervention.
See this image and copyright information in PMC

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