Retrograde Branched Endovascular Repair as a Feasible Option to Treat Complex Aortic Aneurysm Using the Retrograde Branched Extension Limb Assembling Technique

Abstract Purpose To present the primary experiences in treating suprarenal aneurysms, juxtarenal aneurysms, thoracoabdominal aortic aneurysms, and aneurysms after dissection with hostile anatomical features using the retrograde branched extension limb assembling (REBEL) technique. Materials and Methods The study included 23 consecutive patients undergoing total endovascular repair with the REBEL technique from August 2014 to January 2019. Twelve patients had abdominal aortic aneurysms (4 juxtarenal, 8 suprarenal), 6 had thoracoabdominal aortic aneurysms (type IV), and 5 had postdissection aneurysms. The patients were unsuitable for treatment with current off-the-shelf devices or required emergent repair. The evaluated outcomes were technical success, operative mortality, complication morbidity, late survival, endoleakage, and reintervention during follow-up. Results Technical success rate was 100%. In total, 60 visceral vessels were targeted (38 renal arteries, 1 accessory renal artery, 14 superior arteries, and 7 celiac arteries). The mean follow-up period was 20.1 ± 15.1 months (range 2–56), and no aneurysm-related mortality occurred during follow-up. No occlusion of target vessels occurred. Two type II endoleaks and 1 stent migration occurred in 3 (13.0%) patients, and reinterventions were successfully performed. One patient (4.3%) died of myocardial infarction at 38 months. Conclusions The REBEL technique is a feasible option with acceptable results for complex aortic aneurysms. Long-term follow-up of a large sample size is needed to determine the efficacy and durability of this novel technique.