AUTHOR=Kapalla Marvin , Busch Albert , Lutz Brigitta , Nebelung Heiner , Wolk Steffen , Reeps Christian 

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1188501

DOI=10.3389/fcvm.2023.1188501

ISSN=2297-055X

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: Retrospective, monocentric study between 2019 and 2022 including 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. Primary end points were technical and clinical success.

Results: Overall, 77% (n=34) of the patients (mean age 77 ± 6.5 years, n=36 male) were treated with a custom made iBEVAR and 23% (n=10) with an off-the-shelf graft with at least four inner-branches. 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 one-year survival manifested at 95% and branch patency at 98% (177/180). Re-intervention was necessary in 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). 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.