Preliminary results from a multicenter Italian registry on the use of a new branched device for the treatment of thoraco-abdominal aortic aneurysms

Abstract Objective The study purpose was to present early outcomes of patients treated for thoraco-abdominal aortic aneurysms or complex abdominal aortic diseases using endovascular repair with a new branched endograft. Methods This multicenter, retrospective, observational cohort study included all patients treated with a new branched endograft.All elective patients were treated with a staged operative strategy and spinal drainage Primary outcomes of interest were technical success, early (≤30 days) mortality, and late (≥30 days) survival, and freedom from adverse aortic events. Results A total of 16 consecutive patients were treated for Crawford’s extent type 1 (n = 1), type 2 (n = 7), type 3 (n = 1), and type 4 (n = 5), with an additional 2 complex pararenal abdominal aortic lesions (enlarging type 1a endoleak, n = 1; anastomotic pseudoaneurysm, n = 1). There were 13 (81%) male and 3 (19%) female patients with a median age of 72.5 years (IQR, 69-78). The median diameter of the aortic aneurysm was 65mm (IQR, 58-81mm) and the median EuroSCORE prediction for mortality was 18% (IQR, 12-36). Thoraco-abdominal aortic aneurysm was secondary to a previous dissection in 4 patients. A total of 62/64 (96.9%) visceral vessels were stented. Technical success was achieved in 14 (87.5 %) and cumulative aorta-related mortality rate was 19%. Spinal cord ischemia did not occur. Mean of follow-up was 8 ± 4 months (range, 2-15). No type 1 or type 3 endoleaks were detected. Primary bridging stent patency was 98% (1 asymptomatic thrombotic occlusion of a celiac trunk branch). No aortic reintervention was required. Conclusions Endovascular repair of complex aortic aneurysms with this new branched endograft can be performed with high technical success and acceptable morbidity. 19% mortality is quite high but tolerable for such a high-risk cohort. Survival rate was acceptable, and graft-related outcomes at early follow-up included an absence of threatening endoleaks and a high target visceral vessel patency.