Optimizing the target vessel outcomes in patients managed with fenestrated and branched endovascular aortic arch repair

Endovascular aortic arch repair has been applied in high-risk patients with highly acceptable early technical and clinical outcomes in large aortic centers. Despite the increasing literature in the field, the target-vessel related outcomes in patients managed with fenestrated and branched thoracic endovascular aortic repair (f/bTEVAR) have not been extensively investigated. Cohorts mainly reporting on the clinical findings of f/bTEVAR, though, suggest high patency rates; up to 100%, during the mid-term follow-up while reinterventions are mainly attributed to type Ic and IIIc endoleaks, especially in bTEVAR cases. Fenestrations, on the other hand, seem to be more prone to usually asymptomatic bridging stent stenoses due to kinking within the initial year of follow-up. Target-vessel related reinterventions, regardless the underlying approach, are minimal and usually performed successfully using endovascular means. However, until long-term findings are available in the literature, the fate of the bridging stents, target-vessels and further, patients managed with f/bTEVAR remains unknown. Studies focusing on patient specific parameters, including the aortic arch and supra-aortic trunk anatomy, material evolution with dedicated bridging stents, which conform to the large target-vessel diameters and hemodynamics of the aortic arch are scarce. Furthermore, clarifications on the impact of medical treatment on bridging stent performance and long-term outcomes are needed and will hopefully clarify the target-vessel related outcomes in patients managed with f/bTEVAR.