IFT03 - Early and Mid-term Experience with the Inner Branch Endograft for Treatment of Complex Aortic Aneurysms

Objectives: Inner multi-branched endovascular aortic repair (iBEVAR) offers a promising solution for treating challenging elective and emergency complex aortic aneurysms. We report our early and mid-term experience with this technology.

Methods: A prospective analysis of patients treated using either a custom-made or off-the-shelf iBEVAR at two aortic centres in the UK between 2018 and 2024 was conducted. The primary outcome was technical success. The secondary outcomes included procedural-related mortality, complications, target vessel instability and re-interventions.

Results: A total of 103 patients were treated. Indications included juxta/para-renal aneurysm (n=52, 51%), thoracoabdominal aneurysms (n= 2, 26%), T1a endoleak (T1aEL) following previous EVAR (n=9, 8.7%), chronic aortic dissections (n=3, 2.8%), mycotic aneurysms (n=3, 2.8%), and haemodynamically stable aortic ruptures (n=9, 8.7%). The mean aneurysm diameter was 70 ± 17mm. The majority of cases were elective (n=83, 81%) and were preferentially treated using a custom-made endograft to reduce unnecessary aortic coverage. An off-the-shelf device was used in emergency repair. Median follow-up was 19.2 months (range 1 - 77). All patients had successful implantation of iBEVAR with 99.5% target vessel cannulation (in addition to four unilateral and four bilateral iliac branched devices). There were 434 target vessels (418 viscerorenal + 16 iliacs). For the emergencies cases the mean paravisceral aortic lumen was 16.2 mm.

There were 11 (2.5%) late occlusions of branches (6 were renal branches). Freedom from target vessel intervention was 89% at 12 months. Eleven late re-interventions (11%) were performed, six for endoleaks (two T1bEL, two T1cEL and two T3EL successfully treated with extension or relining). Spinal cord ischemia (temporary) occurred in one patient, disabling stroke in two patients and renal failure needing permanent haemodialysis in one patient. 30-day mortality after elective procedure was zero whereas one patient who had a rupture died within 30 days. Cumulative mortality was 14.5 % during follow-up (n=15), all non-aneurysm related (8 elective, and 7 emergency cases).

Conclusions: We report promising early to medium-term outcomes of inner multi-branched endovascular aortic repairs (iBEVAR) for treating complex aortic aneurysms in both elective and emergency settings. The design of the endograft allows applicability in narrow aortic lumens, avoiding unnecessary aortic coverage and offers good freedom from target vessel instability at 12 months.