Branched devices for thoracoabdominal aneurysm repair: Early experience

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Repair

Background:

• Thoracoabdominal aortic aneurysms (TAAAs) pose significant challenges for surgical repair, particularly in high-risk patients.
• Traditional open surgery for TAAAs carries substantial morbidity and mortality rates.
• Limited endovascular options exist for complex TAAA cases, often excluding patients from treatment.

Purpose of the Study:

• To evaluate the initial clinical outcomes and planning experience of branched stent grafts for TAAA repair.
• To assess the feasibility and safety of custom-made branched stent grafts in a high-risk patient cohort.
• To determine the potential of branched stent grafts as an alternative to open surgery for TAAAs.

Main Methods:

• Retrospective analysis of high-risk patients with TAAAs undergoing endovascular repair.
• Design and implantation of custom-made branched stent grafts based on computed tomography angiography (CTA).
• Inclusion of iliac branched devices for associated iliac artery aneurysms in select cases.

Main Results:

• Eleven patients underwent TAAA repair with branched stent grafts, achieving technical success.
• Mean follow-up was 8 months, with procedural complications including renal artery branch occlusion and neurological deficits (paraplegia/paresis).
• Mortality occurred in three patients, two of which were procedurally related; significant hematologic and inflammatory responses were noted.

Conclusions:

• Branched stent grafts are a feasible and potentially effective endovascular treatment for TAAAs.
• This technology offers a viable alternative for patients with TAAAs who are not candidates for open surgical repair.
• Continued advancements in stent graft technology may expand endovascular treatment options for complex aortic aneurysms.