Multi-center Experience With an Off-the-Shelf Single Retrograde Thoracic Branch Endoprosthesis for Acute Aortic Pathology

Acute aortic arch pathology may require coverage of at least one of the supra- aortic trunks. The thoracic branch endoprosthesis (TBE, WL Gore) offers an off-the-shelf single retrograde branch for vessel incorporation in zone 0-2 during thoracic endovascular aortic repair (TEVAR). This study aims to review indications and outcomes of TBE-TEVAR for acute pathology. Clinical data, anatomical imaging, and outcomes of consecutive patients treated with TBE-TEVAR in zones 0-2 at seven institutions were retrospectively reviewed (September 2022- December 2023). Patients treated for acute aortic dissection (AAD), symptomatic aneurysm/pseudoaneurysm, or blunt traumatic aortic injury (BTAI) by urgent/emergent repair were included for analysis. End-points were 30-day mortality, major adverse events (MAEs: any mortality, myocardial infarction, pneumonia requiring prolonged intubation, major stroke, paraplegia, dialysis, or bowel ischemia), and technical success. There were 334 patients treated by TBE-TEVAR during the study period. Of these, 96 patients (67.4% male; mean age, 59 ± 15 years) underwent urgent/emergent repair for acute indications, including 61 (64%) AADs, 20 (21%) symptomatic aneurysms/pseudoaneurysms, and 15 (16%) BTAIs. In eight (8%) patients repair was performed immediately after open ascending repair for Type A AAD. Proximal landing zone was in Zone 2 in 86 (90%) patients and in Zones 0-1 in 10 patients (10%) with cervical debranching procedures. Technical success was achieved in all but one patient (99%) who had AAD with aneurysmal degeneration requiring staged repair. At 30 days, one (1%) patient died and 18 (19%) developed MAEs (Table 1), including major stroke in five (5%) and paraplegia in four (4%). Five patients (5%; all Zone 2) had retrograde aortic dissections without mortality, all in patients with prior AADs at greater than 30 days from initial intervention. Mean follow-up was 57 ± 174 days, and 87 (91%) patients had follow-up imaging. Persistent Type IA or III endoleak occurred in five patients (5%). There was one retrograde branch occlusion (1%), and eight patients (8%) required secondary interventions. Cumulative incidence of aortic-related mortality was two (2%), both from aortic rupture, and four patients (4%) required open repair for type A dissection. TEVAR with the Gore TBE device offers an alternative for patients requiring urgent/emergent repair for acute aortic pathology, with low mortality, stroke, and paraplegia risks. With the increasing use of Gore TBE grafts, there will be a growing collection of data and follow-up available to determine advantages and disadvantages in the treatment of acute aortic pathology.Table IDescription of complications by pathology typePathologyNumber of Patients with complication, No (%)ComplicationAneurysm/pseudoaneurysm (n = 20)1 (1.0%)Death1 (1.0%)RuptureAcute aortic dissection (n = 61)1 (1.0%)Death within 30 days1 (1.0%)Rupture5 (5.2%)Stroke4 (4.2%)Paraplegia3 (3.1%)Death1 (1.0%)Rupture2 (2.1%)Unknown causes3 (3.1%)Dialysis2 (2.1%)Prolonged intubation/pneumonia5 (5.2%)Retrograde dissectionBlunt thoracic aortic injury (n = 15) Open table in a new tab Table IIDescription of procedural details by pathology typePathologyProcedure time, minutesFluoroscopy time, minutesDose area product, mGycm2Contrast volume, mLAneurysm/pseudoaneurysm (n = 20)146 ± 8627 ± 1634632 ± 18607133 ± 67Acute complicated dissection (n = 61)138 ± 8026 ± 2050867 ± 172388129 ± 75BTAI (n = 15)115 ± 7116 ± 56126 ± 5145108 ± 47 Open table in a new tab