Multi-center experience with an off-the-shelf single retrograde thoracic branch endoprosthesis for acute aortic pathology - PubMed (original) (raw)

Multicenter Study

. 2025 Apr;81(4):839-846.

doi: 10.1016/j.jvs.2024.12.007. Epub 2024 Dec 16.

Michelle Manesh 2, Lucas Ruiter Kanamori 3, Mabel Chan 4, Gregory A Magee 2, Fernando Fleischman 2, Jason T Lee 5, Sara L Zettervall 6, Matthew P Sweet 6, Joel P Harding 7, Shahab Toursavadkohi 7, Javairiah Fatima 4, Gustavo S Oderich 3, Sukgu M Han 2, Steven Maximus 3

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Multicenter Study

Multi-center experience with an off-the-shelf single retrograde thoracic branch endoprosthesis for acute aortic pathology

Kathryn L DiLosa et al. J Vasc Surg. 2025 Apr.

Free article

Abstract

Objective: The thoracic branch endoprosthesis (TBE) (W.L. Gore) offers an off-the-shelf single option for thoracic endovascular aortic repair (TEVAR) of aortic arch pathology with sealing in zones 0 to 2. This study reports the early outcomes of TBE-TEVAR for acute indications.

Methods: Clinical data, imaging, and outcomes of patients treated with TBE-TEVAR at seven institutions were retrospectively reviewed (March 2017 to March 2024). Patients treated for complicated aortic dissection, symptomatic aneurysm/pseudoaneurysm, or blunt traumatic aortic injury by urgent/emergent repair were included. End points were 30-day mortality, major adverse events (mortality, myocardial infarction, prolonged intubation, stroke, paraplegia, dialysis, or bowel ischemia), and technical success.

Results: Of 356 patients treated by TBE-TEVAR, 107 (69.0% male; mean age, 60 ± 15 years) underwent repair for acute indications including 70 dissections (65%), 21 symptomatic aneurysms/pseudoaneurysms (20%), and 16 blunt traumatic aortic injuries (15%). Eight patients (8%) had repair immediately after open ascending repair of a type A dissection. Proximal sealing was in zone 2 in 91 patients (89%) and zone 0 to 1 in 11 patients (11%) who required cervical debranching. Technical success was achieved in all (99%) except one patient with acute dissection and aneurysmal degeneration requiring staged repair. At 30 days, two patients (2%) died, and 19 patients (18%) developed major adverse events, including stroke in six patients (6%) and paraplegia in six patients (6%). Five patients (5%; all Zone 2) had retrograde dissections, all treated for acute or subacute dissection, with no mortality. Mean follow-up was 55 ± 171 days, and 96 patients (94%) had follow-up imaging. Type IA or III endoleak occurred in seven patients (7%), retrograde branch occlusion in one (1%), and eleven (10%) required reintervention. Cumulative aortic-related mortality was three (3%) from aortic rupture.

Conclusions: Urgent/emergent TEVAR with the Gore TBE device in acute pathology offers low mortality, stroke, and paraplegia risk. Longer follow-up is needed to assess effectiveness of the repair.

Keywords: Arch branch endograft; Endovascular arch repair; Thoracic aortic repair.

Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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Conflict of interest statement

Disclosures F.F. reports consultant for W.L. Gore; and advisory board for Terumo Scientific and Artivian. S.Z. reports scientific advisory board for W.L. Gore and Terumo; and consultant for Cook Medical. J.F. reports scientific advisory board for W.L. Gore. S.H. reports scientific advisory board for W.L. Gore. G.O. reports scientific advisory board for W.L. Gore; and consultant for Cook Medical and GE.

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