The partial deployment technique (PDT) is an unconventional option of T-branch deployment to allow target arteries (TAs) cannulation/stenting from the upper arm access, in case of narrow (NPA 60°) aorta. Aim of this study was to report outcomes of the endovascular repair of complex aortic (c-AAAs) and thoracoabdominal (TAAAs) aneurysms by T-branch and PDT. All consecutive patients underwent urgent endovascular repair of c-AAAs and TAAAs by T-branch (Cook Medical) and PDT from 2021 to 2023 were analyzed. Technical success (TS), 30-day mortality, and TA instability within 30 days and 1 year, as well as reinterventions, were assessed as primary endpoints. Time of intraoperative pelvic/lower limb ischemia, spinal cord ischemia (SCI), and perioperative stroke were assessed as secondary endpoints. Thirty-three cases were analyzed. There were six type I endoleaks (18%) in failed endovascular aortic repair, nine juxta/para-renal aneurysms (28%), six post-dissection TAAAs (18%), and 12 degenerative TAAAs (36%), respectively. The median para-visceral aortic lumen diameter was 23 mm (interquartile range [IQR], 19-27 mm), and 10 cases (30%) had APA. Of 128 TAs, 111 (87%) were cannulated/stented with distally captured aortic graft. The median time of pelvic/lower limb ischemia was 120 minutes (IQR, 90-150 minutes). TS was achieved in all patients. One patient (3%) suffered SCI, and there were no cases of stroke. An asymptomatic renal artery occlusion was detected at postoperative imaging, which was recanalized by thrombus-aspiration/relining. This was the only case of TA instability (1/128; 0.8%) and reintervention (1/33; 3%) within 30 days. Two patients (6%) died within 30 days. Median follow-up was 14 months (IQR, 6-22 months). One case (3%) of bilateral renal artery occlusion occurred at 6 months. No superior mesenteric artery or celiac trunk events occurred, with an overall TA instability rate of 2% (3/128). Eighteen patients (55%) completed the radiologic follow-up at 1 year with no new cases of TA instability. Freedom from TA instability was 91% at 1 year. T-branch by PDT seems to be safe and effective in the management of c-AAAs/TAAAs with NPA or APA. Results were satisfactory in terms of TS and mid-term TA instability, suggesting a possible enlargement of the anatomical feasibility criteria for outer branches in urgent cases.

Purpose: The purpose was to describe a technique to promote false lumen (FL) thrombosis in post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs) managed by fenestrated/branched endografting (F/B-EVAR). Technique: A 5/6Fr-90 cm length sheath is advanced from the true lumen (TL) to FL through the most distal entry tear of the infrarenal aorta or iliac arteries. It is parked in the most cranial portion of the FL in the thoracic aorta. Aortic endografts are deployed in the TL excluding all the para-visceral/distal entry tears and target visceral vessels bridging stenting is performed. A selective FL angiography is performed through the 5/6Fr sheath to detect the origin of all segmentary arteries. Embolization of FL is performed from above to below by M-reye pushable coils, obtaining the packaging of FL. After completion angiography, the 5/6Fr sheath is retrieved in external iliac artery and molding ballooning of the distal segment of the aortic/iliac endograft is performed. Between 2019 and 2023, this technique was applied in 11cases with a median number of 73 (interquartile range [IQR=12) coils. Out of 8 (72%) patients with available radiological follow-up at 1 year, 7 exhibited complete FL thrombosis. Conclusions: The FL coiling in PD-TAAAs managed by F/B-EVAR is feasible, safe, and effective to promote the complete FL thrombosis. Clinical Impact: Preemptive false lumen embolization is a feasible, safe, and effective technique for preventing persistent type II endoleaks after fenestrated-branched endovascular repair of post-dissection thoracoabdominal aortic aneurysms. This technique may be routinely recommended to promote FL thrombosis and aortic remodeling after FB-EVAR in PD-TAAAs, thereby reducing the incidence of reinterventions during follow-up.

To report outcomes of endovascular repair of complex (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs) by an off-the-shelf mutibranched thoracoabdominal endograft (T-Branch; Cook Medical). This single-center, retrospective study analyzed all consecutive CAAAs and TAAAs managed in elective and urgent setting by T-Branch, between 2014 and 2024. Outcomes were reported according to the Society for Vascular Surgery reporting standards. Technical success (TS), spinal cord ischemia (SCI), and 30-day mortality were assessed as early outcomes. Freedom from reinterventions, target artery (TA) instability, and survival were assessed during follow-up. Of 130 cases, 71 (55%) and 59 (45%) patients were managed in urgent and elective setting, respectively. One hundred fifteen (89%) cases were TAAAs, and 15 (11%) were juxtarenal/pararenal aneurysms. Sixty-seven (52%) cases were performed outside the manufacturer's instructions for use (IFUs). TS was achieved in 118 (91%) cases (elective: 90% vs urgent: 92%) without difference between cases inside and outside IFUs (inside: 92% vs outside: 90%; P = .7). There were 10 (8%) SCI events (elective: 2% vs urgent: 13%) with 3 (2%) cases of paraplegia (elective: 2% vs urgent: 3%). Ruptured TAAAs (P = .02; odds ratio [OR]: 9; 95% confidence interval [CI]: 1.4-58.9) and postoperative mesenteric events (P = .01; OR: 30; 95% CI: 2.1-424.2) were risk factors for SCI. Twelve (9%) patients died within 30 days (elective: 7% vs urgent: 11%). Urgent setting (P = .03; OR: 5; 95% CI: 1.5-30.2), iliac conduit (P = .05; OR: 5; 95% CI: 1.3-9.2), and postoperative cardiac morbidity (P = .001; OR: 15; 95% CI: 1.6-18.5) were risk factors for 30-day mortality. The mean follow-up was 39 ± 22 months. Estimated 3-year freedom from TA occlusion, instability, and reinterventions was 89%, 92%, and 70%, respectively. Urgent TAAA repair (P = .003; hazard ratio [HR]: 2; 95% CI: 1.1-4.2) and Crawford's extent I-III (P = .04; HR: 3; 95% CI: 1.1-5.9) were risk factors for follow-up reinterventions. Estimated 3-year survival was 64%. Urgent TAAAs (P = .03; HR: 3; 95% CI: 1.4-5.8), paraplegia (P = .04; HR: 10; 95% CI: 1.1-86.1), and major adverse events (P = .003; HR: 2; 95% CI: 1.1-3.8) were risk factors for follow-up mortality. Endovascular repair of CAAAs and TAAAs by T-Branch is effective with excellent early outcomes and satisfactory midterm TA instability, reinterventions, and survival. Predictors of early/midterm failures were identified, and they should be considered to optimize patient selection and postoperative management.