Use of the Gore Thoracic Branched Endoprosthesis in Combination With Branched/Fenestrated Physician-modified Endografts in the Treatment of Extent I and II Thoracoabdominal Aneurysms

The Gore TAG thoracic branch endoprosthesis (TBE) is the first United Stages Food and Drug Administration-approved device for Zone 2 thoracic endovascular aortic repairs. There is no published data describing the use of this device as the proximal component for endovascular repair of extent I and II thoracoabdominal aneurysms. Here, we describe our experience with use of the Gore TBE in combination with physician-modified endografts in the treatment of extent I and II thoracoabdominal aneurysms. We retrospectively identified nine patients undergoing placement of Gore TBE as the proximal device in a planned staged repair of extent I and II thoracoabdominal aneurysms. Patient characteristics, procedure details, and outcomes are reported. Between September 2022 and December 2023, 51 patients underwent TBE placement at our institution. Nine cases were planned with the Gore TBE device serving as the proximal component. The modified distal device was a Cook TX2 in seven patients, and a Cook Alpha and Gore Conformable Thoracic Stent Graft in one patient each. Six of nine deployments (66.7%) used left upper extremity access through the side branch to facilitate cannulation of target vessels and deployment of bridging stents. Extent I TAA repairs were planned as two-stage procedures, with an average of 50 days between stages 1 and 2 (Table I). Extent II TAA repairs were completed in three stages, with the third stage consisting of a Gore excluder infrarenal device in all four patients (100%) and bilateral Gore Iliac Branch Endoprosthesis in one patient (25%), with an average of 56 days between stages 2 and 3 (Table II). Technical success was achieved in 100% of patients, with successful stenting of 22 branches and seven fenestrations for 29 target vessels. There were no 30-day or late mortalities or strokes, and one occurrence of spinal cord ischemia in a patient found to have a rapidly expanding aneurysm after initial repair requiring completion of repair 4 days after the index procedure. Average follow-up time with computed tomography angiogram imaging was 138 days, with two patients requiring reintervention. There were no type 1A endoleaks, aortic-related mortality, or rupture in later follow-up. Branch/fenestration primary assisted patency was 100%, with no displacement or thrombosis of the left subclavian side branch in follow-up. In our experience, the Gore TBE provides a safe and effective proximal landing zone when used in conjunction with physician-modified branched/fenestrated endografts.Table IPatient characteristics, procedural details, and outcomes among patients with repair of extent I thoracoabdominal aneurysmsPatient 1Patient 2Patient 3Patient 4Patient 5Mean ± standard deviationAge, years747260707570 ± 6SexFMMFF40% MDiameter of aneurysm prior to repair, cm6.18.75.76.67.26.9 ± 1.2Diameter of aneurysm at last follow-up, cm4.66.25.26.54.65.4 ± 0.9Decrease in diameter after repair, cm1.52.50.50.12.61.4 ± 1.1Type of device modifiedCook TX2 3 branchesGore CTAG1 branchCook TX22 branches, 1 fenestrationCook TX22 branches, 2 fenestrationsCook TX2 2 branches, 2 fenestrationsDevices placedGore TBECook TX2Gore TBEGore CTAGGore TBECook TX2Gore TBECook TX2Gore TBECook TX2Left upper extremity accessNoBrachial exposureNoBrachial exposureNoOperative time (F/BEVAR), minutes274257210441234283 ± 91Days in between each procedure77636130547 ± 12930-day major adverse eventsNoneNoneNoneNoneNoneReinterventionsNoneNoneNoneNoneNoneFollow-up length (last procedure to last CT scan), days18777122307097 ± 60CT, Computed tomography; F, female; F/BEVAR, fenestrated/branched endovascular aneurysm repair; M, male; TBE, thoracic branch endoprosthesis. Open table in a new tab Table IIPatient characteristics, procedural details, and outcomes among patients with repair of extent II thoracoabdominal aneurysmsPatient 1Patient 2Patient 3Patient 4Mean ± standard deviationAge, years5282576063 ± 13SexMFMM75% MDiameter of aneurysm prior to repair, cm6.19.06.56.47.0 ± 1.3Diameter of aneurysm at last follow-up, cm5.58.06.54.96.2 ± 1.4Decrease in diameter after repair, cm0.61.00.01.50.8 ± 0.6Type of device modifiedCook TX22 branchesCook TX24 branchesCook Alpha4 fenestrationsCook TX24 branchesDevices placedGore TBE, Cook TX2, Gore ExcluderGore TBE, Cook TX2, Gore excluderGore TBE, Cook TX2, Gore Excluder, Bilateral iliac endoprosthesisGore TBE, Cook TX2, Gore excluderLeft upper extremity accessBrachial exposureBrachial exposureBrachial exposureBrachial exposureOperative time (F/BEVAR), minutes153281325453303 ± 124Days in between each procedure(stage 2, stage 3)95, 47469, 5851, 6255 ± 38 (stage 2)56 ± 8 (stage 3)30-day major adverse eventsNoneSpinal cord ischemiaNoneNoneReinterventionsRecanalization & restenting of right renal branchNoneCoiling of type 2 endoleakNoneFollow-up length (last procedure to last CT scan), days8436025457189 ± 144CT, Computed tomography; F, female; F/BEVAR, fenestrated/branched endovascular aneurysm repair; M, male; TBE, thoracic branch endoprosthesis. 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