Triple-Branched Stent-Grafts for Total Endovascular Repair of Aortic Arch Pathologies: A Systematic Review

To summarize the early- and mid-term outcomes of triple-branched stent-grafts used for total endovascular repair of aortic arch pathologies.

A systematic literature search of PubMed, Ovid MEDLINE, and Ovid Embase was conducted from January 1999 to May 2026 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Reports describing human clinical experience with endovascular repair of aortic arch pathologies and reconstructing all 3 supra-aortic trunks were included. Single-branched or double-branched stent-graft or hybrid repair with open surgical debranching procedure were excluded.

Seven studies with a total of 194 patients were included. The stent-grafts used for total endovascular arch repair comprised custom-made triple-branched stent-graft for the Zenith (Cook Medical), Relay (Terumo Aortic), and Inoue (PTMC Institute) platforms, the off-the-shelf Concave Supra-arch triple-branched stent-grafts (Lifetech Scientific), and a unibody device integrating one outer branch and 2 inner branches (MicroPort Scientific). Across eligible or separable data, technical success was 97.8% (n = 136/139), 30-day mortality 3.7% (n = 6/162), and stroke 6.2% (n = 10/162). No spinal cord ischemia or retrograde type A dissection was reported, and endoleak occurred in 18/100 patients (18.0%). Patency of the endovascularly reconstructed arch branches was 100% during follow-up. Branch stenosis occurred in 2.4% (4/168) of target vessels. Reintervention was performed in 26/155 patients (16.8%).

Total endovascular aortic arch repair using a triple-branched endograft was feasible and safe with low rate of perioperative mortality and major complications in selected expert aortic centers. Neurologic complications, branch durability, endoleak, and reintervention remain major concerns during total endovascular arch repair.