Endovascular treatment of thoracoabdominal aortic aneurysms with custom-made endografts

Endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs) is a less invasive alternative, with reduced mortality and morbidity compared to open repair. However, reports on the results of this procedure in Brazil are scarce. This article reports the first institutional experience with endovascular treatment of TAAAs using branched and fenestrated endografts. Four patients with TAAA were included in this report. The devices used were custom-made by Braile, tailored to each patient's anatomy based on computed tomography (CT) imaging. A total of 10 visceral branches were required to maintain the patency of the visceral arteries. CT follow-up was performed 2 months after the procedure. All implants were successfully completed. The fenestration/branch interfaces were secured with covered, balloon-expandable, and self-expanding peripheral stents in 8 of the 10 target branches. The remaining 2 branches were preserved with openings and free flow. Post-procedural angiography demonstrated correct positioning of the endografts and stents in the visceral arteries, with patency maintained in 9 of the 10 target branches. Among the complications, one selective catheterization of the celiac trunk was not possible at the first attempt. However, there was no mesenteric ischemia, and a peripheral stent was successfully implanted in the celiac trunk in a second procedure. All patients had a complication-free recovery. Follow-up CT demonstrated complete aneurysm exclusion with no leaks and visceral perfusion was maintained in 7 of the 8 target branches. It was concluded that endovascular treatment of TAAA with custom-made endografts is feasible and may become a treatment of choice for patients with challenging anatomical lesions.