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P3: Plenary Session 3

SS07 - Endovascular aortic arch repair with the Nexus endografts: results from the Italian Nexus Aortic aRCH Endovascular repair Registry (INARCHER)

Thursday, June 5, 2025
8:00 AM - 8:11 AM CT
Location: Morial CC, First Floor, Great Hall A
Objectives: The aim of this study is to evaluate the safety, efficacy, and clinical outcomes of endovascular aortic arch repair using the Nexus and Nexus Duo endograft systems.

Methods: A multicenter, retrospective study with prospectively collected data was conducted as part of the Italian Nexus Aortic aRCH Endovascular Repair Registry (INARCHER) between 2019 and 2024.
Nexus platform include an off the shelf bimodular single branch endograft and a custom-made double branch custom made device. Patients who underwent endovascular aortic arch repair with the Nexus and Nexus Duo endograft systems at participating centers were included. The study addressed both aortic arch aneurysm and dissection. Data collection included baseline patient characteristics, procedural details, and follow-up results. The primary endpoints were early (30 days) major adverse events (MAEs), disabling neurological event and mortality. Secondary endpoints included the need for device related reintervention and the presence of endoleak. Statistical analyses were performed to identify factors associated with adverse outcomes and to assess the overall performance of the endografts.

Results: We collected 26 cases from 8 centers. Mean age was 72.6 ± 7.2, 68% were male. Aortic pathology included 14 cases treated for aneurysm and 12 cases of dissection. Prior endovascular procedures were performed in 4 cases (16%), 14 cases had history of ascending aorta replacement (54%). 22 cases were treated with complete supra-aortic-trunks debranching and Nexus (Figure1), 4 cases with LSA- LCA debranching and Nexus Duo (Figure2). The mean operative time was 230 ± 73 minutes. Technical success was achieved in 96.2% of procedures with one case with persistency of type IA endoleak; however, no reintervention was required due to its lack of clinical significance during follow-up. Perioperative mortality was 3.8% (attributed to side branch thrombosis). Disabling neurological events occurred in 11.5% (2 major strokes and 1 spinal cord ischemia). MAEs rate was 24%. The mean follow-up period was 25 ± 26 months. Beyond 30 days there were no aortic related mortality. No unplanned device-related reinterventions were reported.

Conclusions: The use of the Nexus and Nexus Duo endograft systems appears to be a safe option for the treatment of aortic arch dissection and aneurysm, with complication rates consistent with existing literature for such high-complexity cases. Endovascular aortic arch repair remains a challenging procedure with non-negligible neurological complication, requiring ongoing improvements to enhance patient outcomes.