A Retrospective Analysis of Barb-mediated Active Fixation Impact on Thoracic Endovascular Aortic Repair Outcomes

Active fixation thoracic endografts have been presumed to cause adverse events in patients with aortic syndromes. This study evaluated the outcomes of a barb-fixated thoracic endograft and compared with a non-actively fixated endograft in patients managed for aortic syndromes.

A single center retrospective analysis was conducted using the STROBE guidelines. Patients treated for aortic syndromes with the barb-fixated Zenith TX2 TAA Endovascular Graft (ZTEG) between January 2011 and June 2024 were included. Patients with replaced proximal landing zones and genetic aortic syndromes were excluded. Primary outcomes were migration and migration distance (MD) in patients with at least 12 months of follow-up. A propensity-score matched comparison (1:1) to patients treated with the non-active fixation Zenith TX2 Dissection Endovascular Graft (ZDEG) was performed, after applying the same eligibility criteria.

Ninety-six patients treated with ZTEG were included. No perioperative retrograde type A aortic dissection (rTAAD) or intramural hematoma occurred. Both endoleak Ia and proximal reintervention rates were 6%, each, at 20 months (IQR, 1-54.5). Endograft migration was assessed in 65 patients [median (IQR) follow-up: 33 months (IQR 20-71)], showing a 2 and 20% migration at 1 year and maximum follow-up, respectively, with a median MD of 2 mm (IQR 0-5) and 5 mm (IQR 2-9) at the same timepoints, respectively. The propensity score-matched comparison with 23 ZDEG patients revealed significantly lower 1-year migration (4% vs 35%; p=0.04) and shorter median MD [4 mm (IQR 0-9.5) vs 10 mm (IQR 6-15.5); p=0.016] at maximum follow-up for the ZTEG group. No difference was observed in endoleak Ia, proximal reintervention, or rTAAD rates at any point.

The use of barb-mediated fixation ZTEG endograft in patients with aortic syndromes demonstrated reduced migration and MD compared with the non-actively fixated ZDEG, without differences in rTAAD, endoleak Ia, or proximal reintervention during follow-up.Clinical ImpactThoracic endovascular aortic repair with a barb-fixated endograft (Zenith TX2 TAA Endovascular Graft; ZTEG) in patients with aortic syndromes demonstrated migration rates of 2% at 1 year and 20% at maximum follow-up, with no retrograde dissection (rTAAD). In a propensity score-matched comparison with a non-active fixation endograft (Zenith TX2 Dissection Endovascular Graft; ZDEG), ZTEG showed significantly lower 1-year migration and shorter migration distance at maximum follow-up. No difference was observed in endoleak Ia, proximal reintervention, or rTAAD at any time point. These findings suggest that ZTEG may reduce distal migration without compromising safety regarding retrograde dissection, contrary to existing concerns.