Cook's t-Branch Device Evaluated for EVAR of Acute TAAA
December 13, 2017—The outcomes of endovascular aneurysm repair (EVAR) for acute thoracoabdominal aortic aneurysms (TAAAs) and the applicability of the off-the-shelf (OTS) Zenith t-Branch multibranched stent graft (Cook Medical) were reported by Chiara Mascoli, MD, et al in European Journal of Vascular and Endovascular Surgery (EJVES).
The investigators conducted an investigation of a prospectively maintained database to identify all patients who underwent EVAR for acute TAAA between September 2012 (when the first nonelective t-Branch case was performed) and November 2015. Early and medium-term outcomes were analyzed. Survival and reintervention–free survival were calculated by Kaplan-Meier analysis.
As summarized in EJVES, a total of 39 patients (27 men; mean age, 72 ± 8 years) were treated for acute symptomatic (n = 29) or ruptured (n = 10) TAAAs (20 anatomical extent I–III, 19 extent IV). Fourteen patients had mycotic aneurysms. The mean aneurysm diameter was 80 ± 20 mm. The mean follow-up was 21.4 ± 15.4 months. Surgeon-modified fenestrated EVAR was performed in 24 patients, chimney/periscope EVAR in two, and t-Branch in 13 (33%) patients. Aortic coverage was > 40 mm above the coeliac axis in all patients. A total of 127 target vessels were preserved (mean, 3.3 per patient) and two occluded within 30 days.
The investigators reported that the 30-day mortality rate was 26%. Four (10%) patients developed spinal cord ischemia: two with paraplegia died within 30 days, and two with paraparesis recovered completely with blood pressure manipulation and cerebrospinal fluid drainage. Estimated overall survival at 12 and 24 months was 71.8% ± 7.2% and 63.2% ± 7.9%, respectively. Estimated freedom from reintervention at 12 and 24 months was 93% ± 4.8% and 85.3% ± 6.8%, respectively.
The investigators concluded that EVAR for acute TAAA is associated with acceptable early and midterm results in patients who have no other treatment options. However, only one-third of these patients were suitable for the t-Branch device, indicating that further advances in device design are required to treat the majority of acute TAAA patients with commercially available OTS technology, advised the investigators in EJVES.