Assessing the anatomic applicability of the multibranched endovascular repair of thoracoabdominal aortic aneurysm technique

Abstract

Most patients would have been suitable or could have been made suitable for a thoracoabdominal stent graft using current anatomic criteria. The applicability of MBEVAR will continue to change as the experience with the technique grows and devices evolve, as evidenced by the potential reduction in iliac bypasses after the introduction of a low-profile device and the ability to treat symptomatic or urgent patients with the off-the-shelf device.

Commentary: From Bespoke to Off-the-Shelf: The t-Branch Stent-Graft for Total Endovascular TAAA Repair

“…anatomical data presented in the current article support prior work showing that the distribution of branches on the t-branch stentgraft often matches the distribution of these arteries, 6,7 although it is possible that, in the case of the current study, patient selection may have played a role in eliminating outliers.…”

Application of Zenith t-Branch system in symptomatic thoracoabdominal aortic aneurysm with unfavourable anatomy — case report

“…Gasper [6] and Bisdas [7] retrospectively assessed preoperative AngioCT of elective patients who underwent mbEVAR using CMD. Their relevant results showed that nearly two-thirds of patients (66% and 63%, respectively) where suitable to apply t-Branch, as the method of TAAA treatment.…”

“…4). According to the instruction for use (IFU) and guidelines from previous studies [6,8], abovementioned conditions excluded patient from Zenith t-Branch usage. But taking into consideration high risk of the rupture, waiting for CMD was very hazardous option for this patient.…”

“…The need of solution in such cases led to produce Zenith t-Branch device (Cook Medical, Bloomington, IN, USA). Based on previous studies [6,7] it was proven that more than half of the patients meet criteria for endovascular repair of thoracoabdominal aneurysms (multibranched endovascular aneurysm repair, mbEVAR) using Zenith t-Branch. Recently, it has also received CE approval.…”

Balloon-grab technique to bridge steep renal artery during endovascular thoracoabdominal aortic aneurysm repair: technical note

“…This time frame was not acceptable in urgent cases of symptomatic or ruptured aneurysms. The necessity for off-the-shelf mbSG led to the production of the Zenith t-Branch device (Cook Medical, Bloomington, IN, USA), which according to studies, could be a treatment solution for over twothirds of patients requiring a stent graft [2,3]. However, target artery cannulation and connection with the bridging stents can be challenging in unfavourable anatomy.…”