Early and mid-term results after endovascular repair of thoracoabdominal aortic aneurysms using the off-the-shelf multibranched t-Branch device: a national multi-center study.

Objective : The multibranched off-the-shelf Zenith® t-Branch (Cook Medical, Bloomington, IN) device is commonly chosen for endovascular repair of thoracoabdominal aortic aneurysms. The aim of this study was to report early and mid-term outcomes in all patients treated with the t-Branch in Norway; Design and Methods : A retrospective multicenter study with Norwegian centers performing complex endovascular aortic repair was undertaken. T-Branch patients from 2014 to 2020 were included. All postoperative computed tomography angiography images were reviewed, and demographic, anatomical, perioperative and follow-up data were analyzed; Results: Seventy patients were treated in a single-step ( n  = 55) or staged ( n  = 15) procedure. Symptomatic presentation was seen in 20 patients, six of which had a contained rupture. Technical success was 87% ( n  = 59), with failures caused by unsuccessful bridging of target vessels ( n  = 4), target vessel bleeding ( n  = 3), persisting type 1c endoleak ( n  = 1) and t-Branch malrotation ( n  = 1). 30-day mortality was 9% ( n  = 6) and was associated with high BMI ( p  = .038). The spinal cord ischemia rate was 21% ( n  = 15) and was associated with type II aneurysms (OR 5.4, 95% CI 1.1-26.7, p  = .04), smoking (OR 6.0, 95% CI 1.3-27.6, p  = .02) and intraoperative blood loss (OR 1.1, 95% CI 1.0-1.3, p  = .01). Survival at one, two and three years was 84 ± 4%, 70 ± 6% and 67 ± 6%, respectively. Freedom from aortic-related reinterventions at one, two and three years was 80 ± 5%, 65 ± 7% and 50 ± 8%, respectively; Conclusion : The study showed low early mortality (9%) and satisfactory mid-term survival. Technical success was achieved in acceptable 87% of procedures. The rate of spinal cord ischemia was high, occurring in 21% of patients.