Total endovascular repair using a branched endograft for thoracic aortic arch aneurysm: A single-center experience.

OBJECTIVE

Thoracic endovascular aortic repair (TEVAR) for aortic arch aneurysms remains technically challenging because of supra-aortic vessel involvement and complex arch anatomy. This study evaluated the feasibility and outcomes of branched TEVAR using fenestrated stent grafts in conjunction with small-caliber stent grafts for selective cervical branch reconstruction.

METHODS

From December 2017 to November 2024, 53 patients with degenerative aortic arch aneurysms underwent branched TEVAR at a single center. A Najuta endograft was used as a fenestrated stent graft, with selective branch reconstruction using VIABAHN or VIABAHN VBX stent grafts. The outcomes included technical success, perioperative complications, endoleak occurrence, aneurysm growth, secondary intervention, and survival. The predictors of aneurysm expansion were also analyzed.

RESULTS

Technical success was achieved in all patients. Cervical branch reconstruction was performed in 53 patients (1 branch, n = 23; 2 branches, n = 22; 3 branches, n = 8). There was no 30-day mortality. Ischemic stroke occurred in 2 patients (3.8%). Endoleaks were identified in 7 patients (13.2%) before discharge, and most resolved spontaneously. During an average follow-up period of 884.8 ± 699.1 days (median, 736 days), aneurysm enlargement occurred in 6 patients and 2 required secondary interventions. No aortic-related death was observed. Lower preoperative fibrinogen levels were independently associated with aneurysm expansion (P = .025).

CONCLUSIONS

Branched TEVAR using a fenestrated stent graft combined with small-caliber stent grafts is a feasible and minimally invasive option for selected high-risk patients with aortic arch aneurysms. This approach enables total endovascular arch repair with complete cervical branch reconstruction and demonstrates satisfactory midterm outcomes.