Off the Shelf Multibranched Endograft for Thoraco-Abdominal and Pararenal Abdominal Aortic Aneurysms: a Prospective, Single Centre Study of the G-Branch Endograft.

OBJECTIVE: To investigate outcomes of a novel, off the shelf multibranched endovascular stent graft for the treatment of thoraco-abdominal aortic aneurysm (TAAA) and pararenal abdominal aortic aneurysm (PAAA). METHODS: A prospective, single centre study including 15 patients (mean age, 63.4 ± 10.7 years; 13 male) with TAAA or PAAA treated from October 2019 to March 2021 with a G-Branch endograft (Lifetech Scientific, Shenzhen, China) featuring a mixed multibranch design with two inner and two outer branches for reconstruction of the visceral and bilateral renal arteries, respectively. Follow up assessments were scheduled before discharge and at 30 days, six and 12 months after the index procedure. Annual telephone interviews were performed beyond the initial 12 months. The Kaplan-Meier method was used to estimate cumulative mortality and morbidity rates after endovascular repair. RESULTS: Technical success was achieved in all 15 patients. Nine patients (60%) had TAAA and six (40%) had PAAA (mean maximum aneurysm diameter, 73.7 ± 15.8 mm). The median follow up was 31.4 months (range, 10.1 - 44.0 months). At 30 days, there was no death and 7% morbidity (one case of temporary spinal cord ischaemia on Day 4). At one year, the mortality rate was 7% (one death from stroke at 10 months) and morbidity was 13% (one other case of renal function decline at six months). There were no aneurysm dilatations, re-interventions, or access related complications, and two (13%) persistent type II endoleaks. The one year primary branch patency rate was 100% for the four renovisceral arteries in all 13 patients who underwent computed tomography examinations. One patient died of hepatocellular carcinoma 29 months post-operatively, resulting in an estimated three year mortality rate of 13%. CONCLUSION: The G-Branch endograft yielded high technical success with good early and midterm outcomes for the treatment of TAAA and PAAA. A large multicentre study is warranted.

The 301 Classification: A Proposed Modification to the Stanford Type B Aortic Dissection Classification for Thoracic Endovascular Aortic Repair Prognostication.

OBJECTIVE: To assess the usefulness of a modified Stanford classification for risk stratification of complications after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). PATIENTS AND METHODS: This retrospective analysis included 201 patients from an observational multicenter cohort study who underwent TEVAR for TBAD from January 1, 2011, to December 31, 2016. The patients were divided by using a modified Stanford classification, termed 301, into 3 groups: types B1 (n=62) and B3 (n=24), with a true and false lumen, respectively, descending closely along the thoracic vertebral bodies, and type B2 (n=115), a semi-spiral or spiral configuration. The value of the 301 classification in assessing the risk for post-TEVAR thoracic aortic expansion, as main outcome, and other complications was assessed by using the Kaplan-Meier method and multivariable Cox proportional hazards models. RESULTS: Median follow-up duration was 26.37 months, and the 24-month cumulative rate of freedom from thoracic aortic enlargement was 0.58 (95% CI, 0.25 to 0.81) for type B3, 0.75 (95% CI, 0.64 to 0.83) for type B2, and 0.97 (95% CI, 0.88 to 0.99) for type B1. In the multivariable Cox regression models, types B2 and B3 with type B1 as reference were independently associated with the risk for thoracic aortic expansion (type B2: hazard ratio, 7.81; 95% CI, 1.84 to 33.13; type B3: hazard ratio, 13.91; 95% CI, 2.86 to 67.69). CONCLUSION: The 301 classification, a modified Stanford classification system in the era of endovascular repair, appears to improve the risk stratification of patients with TBAD undergoing TEVAR. TRIAL REGISTRATION: Chinese Clinical Trial Registry number: ChiCTR-POC-17011726.