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Updated: Jan 17, 2026
Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
Early Outcomes of Off-the-Shelf Thoracoabdominal Multibranch Endoprosthesis for Type IA Endoleak from Failed
Kenneth Han1, Ariela Zenilman1, Alyssa J Pyun1
1Comprehensive Aortic Center, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA.
Background:
The Thoracoabdominal Multibranch Endoprosthesis (TAMBE) is the first off-the-shelf four-vessel inner-branched endograft to obtain commercial approval for complex abdominal and thoracoabdominal aortic aneurysms. While off-label TAMBE has been applied to type IA endoleak from failed endovascular aortic repair (EVAR), there is paucity of data regarding outcomes involving this construct. Here, we present early outcomes on rescue TAMBE for type IA endoleak from failed infrarenal and complex EVARs.
Methods:
A retrospective review of patients who received TAMBE at a single institution from April 2020 to February 2025 was performed. Baseline characteristics, intraoperative metrics, and 30-day outcomes were examined.
Results:
Ten patients who received rescue TAMBE for failed EVAR were included. The median interval between failed EVAR and TAMBE was 7 years. Three patients underwent previous attempts at type IA endoleak repair. Overall average age was 80.6 years and maximum aneurysm diameter was 86 mm. Pararenal aneurysms were the most common aneurysm type. Failed previous EVAR devices included infrarenal EVAR (8), single snorkel EVAR (1), and three-vessel Zenith fenestrated (1). Intraoperative metrics included operative time of 259 min, fluoroscopy time of 59.8 min, and contrast usage of 109 mL. Technical success was 100% with no perioperative mortalities. Thirty-day reintervention rate was 10%. This patient required right renal artery angioplasty and stenting due to branch occlusion.
Conclusion:
TAMBE is a promising option for rescue aortic repair of previously failed infrarenal and complex EVAR, with excellent procedural and perioperative outcomes. Longer-term follow-up and larger studies are ongoing to define its durability and broader applicability.
