iCover bridging stent grafts in complex EVAR: mid-term results from an Austrian multicentric study.

BACKGROUND

Bridging stent graft (BSG) durability remains a key limitation of fenestrated and branched endovascular aortic repair (f/bEVAR). This multicenter registry evaluated early and mid-term outcomes of the iCover balloon-expandable covered stent graft as a renovisceral BSG.

METHODS

Consecutive adult patients undergoing f/bEVAR with implantation of at least one iCover BSG between February 2022 and December 2025 were retrospectively included from six Austrian tertiary aortic centers. Only renovisceral target vessels were analyzed. Endpoints included technical success, target vessel patency, BSG-related endoleaks, reinterventions, and survival.

RESULTS

The cohort included 146 patients with a median age of 73.0 years (IQR, 67.0-76.0); 102 patients (69.9%) were male. A total of 494 iCover BSGs were implanted: 104 in the celiac artery, 137 in the superior mesenteric artery, and 253 in renal arteries. Technical success was achieved in 475 BSGs (96.2%). Nineteen technical failures occurred, including 11 renal and 8 visceral target vessels. Median follow-up was 376 days (IQR, 86-755). Target vessel patency was 482/489 evaluable target vessels (98.6%). iCover-related reintervention occurred in 17 patients (11.6%). Type Ic/IIIc endoleaks were observed in 15 (10.5%) patients. Estimated overall survival was 92.9% at 30 days, 86.7% at 1 year, and 84.1% at 2 years.

CONCLUSIONS

In this national multicenter registry, iCover BSGs demonstrated high technical success and favorable early to mid-term patency. Branch-related endoleaks and reinterventions highlight the ongoing importance of renovisceral reconstruction durability after f/bEVAR.