Use of an off the Shelf Inner Branch Thoraco-abdominal Endograft for the Treatment of Juxtarenal and Pararenal Aortic Aneurysms.

Abstract

Objective: To investigate outcomes obtained using an off the shelf pre-loaded inner branched endograft (E-nside) for the treatment of juxtarenal and pararenal aortic aneurysms (J-PRAA).

Methods: Data from a multicentre registry (INBREED), including patients treated with E-nside endograft, were prospectively collected and analysed. Patients treated for J-PRAA were included. Pre-operative clinical and anatomical characteristics, procedural data, 30 day, and one year outcomes were recorded. Endpoints were technical success, 30 day mortality, major adverse events (MAE), and one year freedom from target vessel instability.

Results: Of 185 consecutive treated patients, 47 (25.0%) had a J-PRAA (juxtarenal n = 10, 21.0%; pararenal n = 37, 79.0%) and were included; 183 target vessels were incorporated through an inner branch. Procedural setting was emergent or urgent in 18 patients (38.0%) owing to a contained aortic rupture (n = 2, 4.0%), symptomatic aneurysm (n = 4, 9.0%), or aneurysm > 70 mm (n = 12, 87.0%). Mean length of aortic coverage above the coeliac trunk was 116 ± 7 mm. Technical success was 100%, and 30 day mortality was 4.0% (n = 2 urgent cases). The thirty day cumulative MAE rate was 26.0% (n = 12): two stroke (4.0%); seven spinal cord ischaemia (15.0%); six in an elective setting (20.0%) and one in an urgent setting (6.0%), and five leading to permanent paraplegia/paraparesis (10.0%). Freedom from target vessel instability was 99.0% after 30 days and 97.0 ± 3.0% after one year.

Conclusion: Use of an off the shelf inner branched device for treating J-PRAA was feasible in urgent and elective settings, with high technical success and satisfactory target vessel stability at one year. In the treatment of J-PRAA, stroke and spinal cord ischaemia may be associated with arm access and increased aortic coverage that the design brings.