Complex endovascular arch repair using fenestrated and branched devices: a single-centre experience

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Disease Management

Background:

• Endovascular arch repair is an alternative to open surgery for high-risk patients.
• Complications persist, especially in elderly and urgent cases.

Purpose of the Study:

• To evaluate the institutional experience with endovascular arch repair at a high-volume aortic center.
• To analyze outcomes in specific subgroups: urgent settings, octogenarians, and different graft designs.

Main Methods:

• Retrospective, single-center study of 74 patients undergoing endovascular arch repair.
• Outcomes assessed included technical success, 30-day mortality/morbidity, survival, reintervention, endoleak, and target vessel instability.
• Subgroup analyses were performed for urgent repairs, octogenarians, and fenestrated/branched endografts.

Main Results:

• Technical success rate was 93.2%.
• Urgent repairs had significantly higher rates of technical failure (22.2%), 30-day mortality (44.4%), and stroke (22.2%) compared to elective repairs.
• Octogenarians had higher 30-day mortality but similar major adverse events. Branched endografts showed higher endoleak and reintervention rates.

Conclusions:

• Endovascular arch repair is feasible with satisfactory outcomes in high-risk, elective patients.
• Urgent and elderly patient groups remain challenging, highlighting the need for meticulous patient selection.
• Custom-made fenestrated/branched endografts demonstrate potential but require careful consideration of graft design.