Anatomic Suitability of Left Subclavian Artery Off-The-Shelf Branch Graft in a Real-World Setting

This study aimed to analyze the anatomical suitability of thoracic branch excluder (TBE), an "off-the-shelf" stent graft, in routine practice at a tertiary French hospital.

This was a single center, retrospective, cross-sectional study. We included patients who underwent thoracic endovascular aortic repair (TEVAR) in zone 2 or in zone 3 with the lesion located <30 mm from the left subclavian artery (LSA), between 2010 and 2024. The morphological parameters of the aorta were measured, and eligibility for TBE (WL Gore, Phoenix, USA) placement was evaluated according to the manufacturer's instructions for use.

From the 210 TEVAR procedures performed during the study period, 97 patients were included. These patients were predominantly male (80.4%), with a median age of 61 years (interquartile range: 44.0-73.0). Emergency TEVAR was performed in 79.4% of cases. TBE placement was anatomically suitable in 82.5% (80/97) of included cases and in 38.1% (80/210) of all TEVAR procedures. The most frequent cause of anatomical unsuitability was proximal segment length (distance between the distal edge of the LSA and the midpoint of the ostium of the left common carotid artery <20 mm) in 9.3% of cases. Although the aortic and LSA diameters were smaller in patients treated for blunt traumatic thoracic aortic injury, the rate of unsuitability of TBE placement due to anatomical characteristics was similar whatever the underlying disease.

This eligibility study highlights the interest of TBE endografts for the management of thoracic aortic lesions, demonstrating their suitability in a wide range of clinical settings. The clinical relevance of this endograft remains to be determined.