Total endovascular repair using a branched endograft for thoracic aortic arch aneurysm: A single-center experience

Objective: Thoracic endovascular aortic repair (TEVAR) for aortic arch aneurysms remains technically challenging because of supra-aortic vessel involvement and complex arch anatomy. This study evaluated the feasibility and outcomes of branched TEVAR using fenestrated stent grafts in conjunction with small-caliber stent grafts for selective cervical branch reconstruction. Methods: From December 2017 to November 2024, 53 patients with degenerative aortic arch aneurysms underwent branched TEVAR at a single center. A Najuta endograft was used as a fenestrated stent graft, with selective branch reconstruction using VIABAHN or VIABAHN VBX stent grafts. The outcomes included technical success, perioperative complications, endoleak occurrence, aneurysm growth, secondary intervention, and survival. The predictors of aneurysm expansion were also analyzed. Conclusions: Branched TEVAR using a fenestrated stent graft combined with small-caliber stent grafts is a feasible and minimally invasive option for selected high-risk patients with aortic arch aneurysms. This approach enables total endovascular arch repair with complete cervical branch reconstruction and demonstrates satisfactory midterm outcomes.