Short-Term Outcomes Following Thoracic Branch Endoprosthesis: A Retrospective Cohort

Objective Endovascular management of thoracic aortic arch pathology often necessitates coverage of aortic branch vessels for proximal seal. Historically this was managed with extra-anatomic debranching. New endovascular devices provide alternative management options. We report our centre's experience using the Gore TAG Thoracic Branch Endoprosthesis (TBE) for endovascular repair at the aortic arch. Methods We performed a single-center retrospective review of all patients undergoing implantation of the Gore TAG TBE. Demographics, aortic characteristics, and 30-day outcomes were collected. Results Fifty patients were included (median age 70 years, IQR 14); 58% were male. The most common indication was aneurysmal disease (30%), followed by penetrating aortic ulcer (26%). Deployment occurred in zone 2 (n=39), zone 1 (n=7), and zone 0 (n=4). Fifteen patients underwent concomitant or pre-operative debranching to establish a proximal landing zone. In-hospital mortality was 4% (n=2). Spinal cord ischemia occurred in one patient (2%) with complete resolution prior to discharge. There were 2(4.0%) documented cerebrovascular accidents post-operatively and 7(14%) access site complications. Endoleak was identified on predischarge CT imaging in ten patients. Four patients required reintervention within 30 days, one each for branch occlusion, proximal endoleak, femoral pseudoaneurysm, and iliac stent thrombosis. Conclusions This study examined the largest cohort of Canadian patients treated with Gore TAG TBE for thoracic aortic pathology and found favorable short-term results in challenging anatomy. Both perioperative mortalities occurred in octogenarians with acute pathology. Neurologic deficits resolved prior to discharge, and branch patency was 98%. Further study is needed to define optimal patient and anatomic selection.