Early Multicentre Experience with Exclusively Retrograde Multiple Branched Endovascular Aortic Arch Repair

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Surgery

Background:

• Endovascular aortic arch repair traditionally requires large-bore access, posing risks.
• Custom endografts with retrograde inner branches offer a potential alternative approach.

Purpose of the Study:

• To evaluate the initial experience and outcomes of endovascular aortic arch repair using exclusively retrograde inner branches.
• To assess technical success, peri-operative morbidity, and mortality associated with this novel technique.

Main Methods:

• Retrospective review of 21 patients undergoing endovascular aortic arch repair with custom retrograde inner branch endografts.
• Data collected from seven tertiary centers between June 2022 and December 2024.
• Primary endpoints included technical success, morbidity, and mortality.

Main Results:

• Technical success was achieved in 18 of 21 patients.
• No branch-related re-interventions were required.
• Aortic graft stenosis at the arch occurred in three patients, requiring correction.

Conclusions:

• Endovascular aortic arch repair with retrograde inner branches is feasible and achieves acceptable technical success.
• Aortic graft stenosis is a potential complication requiring further investigation.
• This technique may reduce the need for large-bore upper extremity or carotid access.