The United Kingdom Branch Endoprosthesis for Aortic arch Treatment study: Early experience with the GORE TAG thoracic branch endoprosthesis.

Abstract

Thoracic endovascular aortic repair is established for descending thoracic aortic pathology but becomes more complex when proximal sealing requires coverage of supra-aortic branches. Off-the-shelf thoracic branch endografts have expanded endovascular options for arch-adjacent disease; however, real-world multicenter data remains limited. This study reports early outcomes of thoracic branch endograft repair for arch-adjacent thoracic aortic pathology in routine UK practice. This is a retrospective multicenter cohort study conducted across 13 UK vascular centers. All consecutive patients undergoing endovascular repair of arch-adjacent thoracic aortic pathology using the GORE TAG Thoracic Branch Endoprosthesis (TBE; W. L. Gore & Associates) between January 2024 and September 2025 were included. Indications included degenerative aneurysm, acute and chronic type B dissection, penetrating aortic ulcer, intramural hematoma, and post-traumatic pseudoaneurysm. Both elective and nonelective procedures were analyzed. Primary outcomes included technical success and early clinical outcomes. Secondary outcomes included neurological complications, reintervention, endoleak profile, target vessel, and branch patency. Seventy patients were included. Mean age was 65 years, and 62.9% patients were males. Nearly half of procedures were performed urgently or in a nonelective setting 45.7% (32/70). Proximal sealing was achieved in zone 2 in 88.6% of cases (62/70), with the remainder in zones 0 and 1. Technical success was achieved in 65/70 patients (92.9%). Thirty-day mortality was 2.9% (2/70). Stroke occurred in 4.3% of patients (3/70), and spinal cord ischemia occurred in 1.4% (1/70), with no cases of paraplegia. Target vessel and branch patency were achieved in all cases who had follow-up imaging 100% (67/67). Reintervention was required in 8.6% of patients with only one case requiring a device-related reintervention (1.4%). In this multicenter UK experience, thoracic branch endograft repair for arch-adjacent thoracic aortic pathology was associated with high technical success and acceptable early outcomes in a heterogeneous real-world population. These findings support the use of thoracic branch endografting with Gore TBE as a pragmatic endovascular option for complex arch-adjacent disease.