複雑大動脈瘤における頭蓋側標的血管を伴う患者特異的腸骨グラフトの早期および後期転帰

To evaluate the early and late outcomes of patient-specific endografts with retrograde outer branches for the treatment of complex aortic aneurysms involving cranially oriented target vessels (TVs).

This multicenter retrospective study incorporated both prospectively and retrospectively collected data from consecutive patients who underwent fenestrated-branched endovascular aortic repair using patient-specific endografts with retrograde branches for complex aortic aneurysms with cranially oriented TVs from August 1, 2015, to October 31, 2024. Cranial orientation was defined as an aorta-to-vessel origin angle greater than 30°. The primary outcome was retrograde branch-related target artery instability (TAI). Secondary outcomes included retrograde branch-related mortality, major adverse events, and reinterventions. Outcomes were categorized as early (within 30 days postoperatively or during hospitalization) or late events (occurring beyond 30 days after the index procedure and after hospital discharge).

Twelve patients (9 male patients; median age: 77 years; interquartile range: 70.5-80 years) were analyzed. A total of 49 vessels were targeted, and 14 (28.6%) were incorporated with retrograde branches. There were no retrograde branch-related intraoperative complications. The technical success rate was 100%. The rate of early retrograde branch-related TAI was 7.1% (1/14). There were no early major adverse events. Among the 49 TVs treated, the rate of early reintervention was 4.1% (2/49), with one case being retrograde branch-related. The median follow-up was 31 months (interquartile range: 13.5-54 months). Two-year cumulative incidence of both retrograde branch-related TAI and mortality was 0.0%; however, one right renal artery incorporated with a retrograde branch occluded at postoperative 4 years. There was one late death at 2.8 years, which was not retrograde branch-related.

The use of patient-specific endografts with retrograde branches is a feasible technique. It enabled the incorporation of TV with cranial orientation during the fenestrated-branched endovascular aortic repair procedure and demonstrated high technical success with low incidence of retrograde branch-related adverse events.