TOTAL ENDOVASCULAR AORTIC ARCH REPAIR WITH BRANCHED DEVICES: 7-YEAR EXPERIENCE

Purpose: Endovascular aortic arch stent grafting (Ar-TEVAR) with branched devices offers a less invasive alternative with promising early results. This study aims to evaluate early and long-term outcomes of Ar-TEVAR in high-risk patients. Methods: Between 2017 and 2024, 16 consecutive patients underwent Ar-TEVAR at our institution using the Nexus aortic-arch system and RelayBranch devices. Data were prospectively collected and retrospectively analyzed. The primary endpoint was overall survival; secondary endpoints included procedure-related reinterventions, stroke, paraplegia, and endoleaks. Patients were followed-up with clinical examinations and computed tomography angiography (CTA) at discharge, 6 months, and annually for up to 7 years. Results: The mean patient age was 74.1 ± 6.8 years, with a mean Euroscore II of 8.4 ± 2.3. Ten patients (62%) had a history of previous open repair for type A aortic dissection. The overall 30-day mortality rate was 12% (2 patients). At 30 days, secondary procedures were performed in 2 patients (12%). No major strokes or paraplegia were observed, while minor strokes occurred in 5 patients (30%). One patient (6%) experienced a type III endoleak. The median follow-up duration was 24 months (IQR 4-60). Overall survival rates were 73.4% at 12 months, 65.3% at 24-60 months, and 43.5% at 72 months. Conclusions: Ar-TEVAR with branched devices demonstrates good outcomes up to 7 years in a high-risk cohort, with no major strokes, no paraplegia, and a low incidence of endoleaks. This procedure is a viable option for patients, especially those with previous open ascending repair for type-A dissection.