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Early and late outcomes of patient-specific endografts with retrograde outer branches for complex aortic aneurysms

Bruno Pagnin Schmid1,2, Lucas Ruiter Kanamori1, Mohamed Ahmed Abdelhalim3

  • 1Advanced Endovascular Aortic Research Program, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.

Journal of Vascular Surgery Cases and Innovative Techniques
|February 2, 2026
PubMed

Insights

Patient-specific endografts with retrograde branches offer a feasible solution for complex aortic aneurysms, successfully treating cranially oriented target vessels (TVs) with high technical success and low adverse events.

Area of Science:

  • Vascular Surgery
  • Endovascular Repair
  • Aortic Aneurysm Treatment

Background:

  • Complex aortic aneurysms often involve challenging target vessels (TVs) with cranial orientation.
  • Conventional fenestrated-branched endovascular aortic repair (FBEVAR) may face difficulties in treating these anatomies.

Purpose of the Study:

  • To evaluate the early and late outcomes of using patient-specific endografts with retrograde outer branches.
  • To assess the feasibility and safety of this technique for complex aortic aneurysms with cranially oriented TVs.

Main Methods:

  • A multicenter retrospective study analyzed data from patients undergoing FBEVAR with patient-specific endografts and retrograde branches.
  • Cranial orientation was defined as an aorta-to-vessel origin angle >30°.
  • Outcomes included retrograde branch-related target artery instability (TAI), mortality, major adverse events, and reinterventions, categorized as early or late.

Main Results:

  • Twelve patients with 49 targeted vessels were analyzed; 14 vessels were incorporated using retrograde branches.
  • 100% technical success was achieved with no intraoperative retrograde branch complications.
  • Early retrograde branch-related TAI occurred in 7.1% of treated branches, with no early major adverse events. Late occlusion of one retrograde branch occurred at 4 years.

Conclusions:

  • Patient-specific endografts with retrograde branches are a feasible technique for FBEVAR.
  • This approach enables the treatment of cranially oriented target vessels.
  • The technique demonstrates high technical success and a low incidence of retrograde branch-related adverse events.
Abstract

Keywords:
Complex aortic aneurysmFenestrated-branched endovascular aortic repairPatient-specific endograftRetrograde outer branchTarget artery instability

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