Outcomes of Inner Branches in Endovascular Repair of Complex Abdominal and Thoracoabdominal Aortic Aneurysms.

Abstract

The aim of the present study was to report outcomes of inner branches of the Cook Platform in endovascular repair of complex abdominal (cAAAs) and thoracoabdominal aortic aneurysms (TAAAs). All consecutive patients treated at two institutions with F/BEVAR 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 mortality, target vessel patency, freedom from endoleak, target vessel related re-intervention, and target vessel instability (TVI) for vessels addressed with inner branches. A total of 108 patients (79 male, mean age 71 ± 8.9 years) with 181 inner branches were analysed. Nineteen (17.6%) patients had a cAAA and 89 (82.4%) patients a TAAA. A stent graft with fenestrations and inner branches was used in 92 (85.2%) patients. Thirty day mortality was 3.7% (4/108). Technical success per inner branch was 98.9% (179/181). 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 compared with 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 only (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 over grafts with inner branches only, presenting higher patency and lower TVI rates.