Early Outcomes of Thoracic Branch Endoprosthesis in Aortic Arch Pathologies: A Nordic Multicentre Study.

OBJECTIVE

This study evaluated the feasibility and early clinical outcomes of the Gore thoracic branch endoprosthesis (TBE) in the treatment of aortic arch pathologies.

METHODS

This multicentre retrospective study, conducted and reported in accordance with the STROBE statement, included consecutive patients undergoing thoracic endovascular aortic repair with TBE between February 2024 and July 2025. No restrictions were applied regarding the type or extent of aortic disease, use of staged procedures, or concomitant adjunctive endovascular interventions. Primary endpoints were technical success, thirty day mortality, and overall survival, while endoleak occurrence, primary target vessel patency, stroke, and spinal cord ischaemia (SCI) were secondary.

RESULTS

Sixty-four patients (median age 73 years [interquartile range 59, 77]; 69% men) were included. Indications for treatment included degenerative aneurysm (n = 26; 41%), chronic dissection (n = 18; 28%), subacute dissection (n = 11; 17%), and acute dissection (n = 9; 14%). The left subclavian artery was the target vessel in 59 cases (92%), followed by the brachiocephalic trunk in three (5%) and the left common carotid artery in two (3%). Technical success was achieved in 95% of cases (n = 61), with failures attributed to two type Ia endoleaks and one type IIIa endoleak. Thirty day mortality was 3% (n = 2). Early unplanned re-interventions occurred in four patients (6%). No strokes or SCI were observed. Median follow up was 6 months (2, 10). No late mortality was observed, and primary patency of all branches was 100%. One late unplanned re-intervention, unrelated to the TBE device, was required. During follow up, 12 patients (19%) had endoleaks, including type II (n = 4), type Ia (n = 4), type Ib (n = 2), type III (n = 1), and type V (n = 1). Estimated freedom from type Ia endoleak at 12 months was 93 ± 3%, while estimated overall survival at 12 months was 97 ± 2%.

CONCLUSION

TBE demonstrated high technical success and acceptable early outcomes across a range of aortic arch pathologies. However, the relatively high rate of endoleaks and need for early re-interventions highlight the importance of careful patient selection and close continuous post-operative surveillance.