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 treatment of thoraco-abdominal aortic aneurysm (TAAA) and pararenal abdominal aortic aneurysm (PAAA).

METHODS: 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 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, 6 months and 12 months after the index procedure. Annual telephone interviews were performed beyond the initial 12 months post-operatively. The Kaplan-Meier method was used to estimate cumulative rates of mortality and morbidity 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 time was 31.4 months (range, 10.1 - 44.0 months). At 30 days, there was no mortality and 7% morbidity (one case of temporary spinal cord ischaemia on Day 4). At 1 year, the mortality was 7% (one death from stroke at 10 months) and morbidity was 13% (one other case of renal function decline at 6 months). There were no aneurysm dilatations, re-interventions, or access related complications, and two (13%) persistent type II endoleaks. The 1 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 at 29 months post-operatively, resulting in an estimated 3 year mortality 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.