Early Outcomes of the t-Branch Off-the-Shelf Multibranched Stent-Graft in Urgent Thoracoabdominal Aortic Aneurysm Repair

Abstract

Endovascular repair of urgent TAAA using the t-Branch is a feasible treatment option with acceptable 30-day mortality and morbidity in terms of SCI and renal function impairment. Adherence to the IFU prolonged procedure time but had no effect on outcomes. Increased experience of such cases over time may improve outcomes.

A novel all-retrograde approach for t-Branch implantation in ruptured thoracoabdominal aneurysm

“…The t-Branch device has proved to be a successful therapy but still carries a 6% to 14% 30-day mortality and a 6% to 21% rate of spinal cord ischemia. 4 , 5 When it is used to treat aortic rupture, the success of the t-Branch device depends on an expeditious operative time. In the recent experience of Spanos et al 5 reporting t-Branch use in urgent TAAA, mean operative time of experienced users was 407 minutes and as high as 497 minutes in technically challenging cases.…”

“… 4 , 5 When it is used to treat aortic rupture, the success of the t-Branch device depends on an expeditious operative time. In the recent experience of Spanos et al 5 reporting t-Branch use in urgent TAAA, mean operative time of experienced users was 407 minutes and as high as 497 minutes in technically challenging cases. The ability to cannulate branch vessels expeditiously from a single access reduced the operative time to 98 minutes in our case.…”

“… 3 Current implantation techniques require upper limb access to catheterize branches. 4 , 5 Upper extremity access may lengthen procedures and contribute to complications and, potentially, stroke rate. 5 We report a single-femoral access, ruptured TAAA repair using retrograde side-branch cannulation with the Aptus Heli-FX Guide (Medtronic, Santa Rosa, Calif).…”

Aortenaneurysma: fenestrierte/gebranchte abdominale EVAR (fbEVAR) und fenestrierte/gebranchte thorakale EVAR (fbTEVAR). Ist die komplette endovaskuläre Therapie schon da?

“…Die [17], zeigte ähnlich zu den Ergebnissen der elektiven Verfahren einen technischen Erfolg in 93 % der Fälle. Von 155 Zielgefäßen wurden 151 erfolgreich katheterisiert (97,4 %) und die Branches blieben zu 99 % innerhalb des 1.…”

Early Outcomes After Branched and Fenestrated Endovascular Aortic Repair in Octogenarians

“…For urgent cases with para/suprarenal aneurysms, surgeon modified fenestrated and branched stent grafts, or for the thoraco-abdominal aneurysms off the shelf multi-branched endografts (t-Branch, Cook Medical, Bloomington IN, USA), were used. 16,17 For the surgeon modified stent grafts an off the shelf thoracic stent graft was chosen and the necessary opening and reinforcement of all fenestrations was performed on the back table, while the patient was prepared for the procedure. 17…”