Outcomes of Inner Branches in Endovascular Repair of Complex Abdominal and Thoraco-abdominal Aortic Aneurysms

The aim of the present study was to report the outcomes of inner branches of the Cook platform in endovascular repair of complex abdominal aortic aneurysms (cAAAs) and thoraco-abdominal aortic aneurysms (TAAAs).

All consecutive patients treated at two institutions with fenestrated and branched endovascular aortic repair for cAAA or TAAA using stent grafts with inner branches between April 2015 and December 2024 were included. Analysed endpoints included technical success, peri-operative death, target vessel patency, freedom from endoleak, target vessel related re-intervention, and target vessel instability (TVI) for vessels addressed with inner branches.

One hundred and eight patients (79 men, mean age 71 ± 8.9 years) with 181 inner branches were analysed. Nineteen (17.6%) patients had a cAAA and 89 (82.4%) a TAAA. A stent graft with fenestrations and inner branches was used in 92 (85.2%) patients. Thirty day mortality was 3.7% (4 of 108). Technical success per inner branch was 98.9% (179 of 181). Estimated patencies at 1 and 2 years were 95.0 ± 1.7% and 90.5 ± 2.6%, respectively. Estimated patency at 2 years was lower for the renal arteries than the splanchnic arteries (80.4 ± 5.3% vs. 98.9 ± 1.1%, respectively; p = .002). Estimated freedom from TVI for vessels treated with inner branches at 1 and 2 years was 93.3 ± 1.5% and 87.6 ± 2.2%, respectively. Estimated freedom from TVI at 2 years was higher for grafts with a combination of fenestrations and inner branches compared with grafts with inner branches alone (91.4 ± 3.0% vs. 79.5 ± 6.5%; p = .022).

Inner branches were associated with excellent technical success rates. Renal arteries were associated with higher occlusion rates at 2 years compared with splanchnic arteries. Grafts with a combination of inner branches and fenestrations might be preferable to grafts with inner branches alone, enjoying higher patency and lower TVI rates.