RS12 - Potential role of a new off-the-shelf preloaded inner branch device for urgent endovascular Thoraco-Abdominal Aortic Aneurysm repair

Objectives: To report the outcomes of urgent endovascular Thoracoabdominal Aortic Aneurysm (TAAA) repair, using a new off-the-shelf preloaded inner branch device (E-nside, Artivion - Kennesaw, GA – USA).

Methods: Data from a physician-initiated national multicenter registry including patients treated with E-nside endograft (INBREED) were prospectively collected (2020-2023); only urgent cases were included in this study. Primary outcomes were technical success and mortality at 30 days. Secondary outcomes were spinal cord ischemia rate, stroke rate, major adverse events (MAE) and branch instability at 12 months.

Results: Of the 172 patients treated in the INBREED registry, 35 patients were treated in a urgent setting owing to a symptomatic non-ruptured aneurysm (n=29), ruptured aneurysm (n=4) or pseudoaneurysm (n=2). Aneurysm extension was I-III in 16 cases (46%), extent IV in 9 (25%), and juxta/pararenal in 10 (28%). Mean aneurysm diameter was 72±15 mm and 9 (25%) patients had a narrow ( < 25 mm) paravisceral aortic lumen. Mean bridging time required for target vessel cannulation and stenting was 24.3±6.2 min; an adjunctive thoracic endograft was deployed in 18 cases (51%). Distal landing was in the infrarenal aorta in 16 cases (46%) while a distal bifurcated abdominal graft was deployed in 19 (54%).
Early mortality occurred in 5 patients (14%) and thirty-days cumulative MAE rate was 50%. There were no postoperative strokes and spinal cord ischemia rate was 6% (n=2). For the 132 target vessels successfully incorporated through an inner branch, freedom from target vessel instability was 98% after 30 days and 92±3% after 1 year. The narrow aortic lumen did not impact on branches stability (HR 1.21, 95%CI 0.72-2.45; P=863).

Conclusions: This new off-the-shelf endograft may play a role in urgent TAAA repair; the preloaded system allows to mitigate time-spending maneuvers for complete target vessels bridging, and the two available distal graft diameters may be helpful in selected cases to land in the infrarenal aorta, reducing distal length of coverage. The inner branch conformation allowed for its use in case of narrow aortic lumen without impact on 1 year branch stability. Further studies are required to assess the clinical role of E-nside for urgent TAAA repair.