AUTHOR=Nana Petroula , Spanos Konstantinos , Jakimowicz Tomasz , Torrealba Jose I. , Jama Katarzyna , Panuccio Giuseppe , Rohlffs Fiona , Kölbel Tilo 

TITLE=Urgent and emergent repair of complex aortic aneurysms using an off-the-shelf branched device

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1277459

DOI=10.3389/fcvm.2023.1277459

ISSN=2297-055X

ABSTRACT=Introduction: Endovascular repair using off-the-shelf endografts is a viable solution in patients with ruptured or symptomatic complex aortic aneurysms. This analysis aimed to present the peri-operative and follow-up outcomes in urgent and emergent cases managed with the t-Branch multibranched thoracoabdominal endograft. 
Methods: Prospectively collected data from all consecutive urgent and emergent cases managed in two aortic centers between January 1st, 2014, to November 30th, 2022, using the t-Branch device (Cook Medical Inc., Bjaeverskov, Denmark) were analyzed. Patients presenting with ruptured aortic complex aneurysms were characterized as emergent and patients with aneurysms >90mm of diameter, or symptomatic aneurysms were characterized as urgent. Technical success, 30-day mortality, major adverse events (MAE) and spinal cord ischemia (SCI) rates were assessed. 
Results: 225 patients (36.5% females, 72.5 ± 2.8 years) were included; 73.0% were urgent. The mean aneurysm diameter was 109 ± 3.9 mm and 44.4% were type I-III TAAAs. Females (p=.03), para-renal aneurysms (p=.02) and ASA score IV (p<.001) were more common in emergent cases. Technical success was 97.8%. Thirty-day mortality and MAE rates were 17.8% and 30.6%, respectively. SCI rate was 14.7%, with a 4.8% paraplegia rate with 22.2% of patients receiving prophylactic cerebrospinal drainage. Thirty-day mortality (13.3% vs 26.7%, p=.04) and MAE (26.0% vs 43.0%, p=.02) were more common among emergent cases while technical success (97.6% vs 98.3%, p=.9), and SCI (13.3% vs 18.3%, p=.4) were similar. Survival at 12-months was 83.5% (SE 5.9%) for the urgent and 77.1% (SE 8.2%) for the emergent group (log rank, p=0.96). 
Conclusion: T-Branch represents an effective and safe solution for the management of urgent and emergent cases with complex aortic aneurysms, with high technical success, promising early mortality and SCI rates.