An appraisal of bridging stents outcomes for target vessel incorporation in fenestrated and branched endovascular aortic repair in the United States Aortic Research Consortium.

Target vessel incorporation with bridging balloon- and self-expandable stent grafts is an essential component to the long-term success of fenestrated and branched endovascular aortic repair (FB-EVAR). This narrative review summarizes contemporary evidence regarding bridging stent-graft performance and target vessel outcomes during FB-EVAR, with emphasis on analyses from sponsor-investigator investigational device exemption (SI-IDE) protocols and United States Aortic Research Consortium (US-ARC). FB-EVAR achieves high technical success and durable mid-term target vessel (TV) patency, with 5-year primary and secondary patency rates generally exceeding 90%. Target vessel instability (TVI) is mainly driven by TV-related complications such as stenosis, occlusion, and type Ic/IIIc endoleaks. Reinforced fenestrations tend to provide superior renal durability compared with directional branches, although most studies were biased by differences in aneurysm extent with predominance of directional branches in more extensive aneurysms. Furthermore, fenestrations are generally best suited for patients with narrow aortic luminal diameter and a fenestration-aortic wall gap distance <5 mm. US-ARC analyses also suggest that self-expandable and hybrid stent-graft constructs reduce the incidence of target events, primarily less endoleaks and reinterventions compared to balloon-expandable stent-grafts, while maintaining similar patency rates. Overall, most secondary interventions are minor and can be performed using percutaneous approach.