Technical considerations and contemporary literature review of the Gore Thoracic Branch Endoprosthesis®

Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment for various thoracic aortic pathologies, including blunt thoracic aortic injury, aneurysms, and dissections. Involvement of Ishimaru Zone 2 occurs in up to 60% of TEVAR cases requiring extension across the distal aortic arch and left subclavian artery (LSA). Coverage of the LSA without revascularization increases the risk of complications such as upper extremity ischemia, stroke, and spinal cord injury. Therefore, the preservation of LSA perfusion during TEVAR is essential. Cervical debranching remains an effective alternative to preserve flow to the LSA, but it poses risks of bleeding, infection, and nerve injury. Similarly, although technically feasible, other endovascular approaches, such as parallel grafts, in situ fenestrations and physician-modified endografts, may lead to added risk of stent-graft complications and are considered off-label indications. To address these challenges, the Gore Thoracic Branch Endoprosthesis^® (TBE; W.L. Gore & Associates, Flagstaff, AZ, USA) has emerged as an off-the-shelf thoracic branch stent-graft for the treatment of distal aortic arch lesions that require extension of the proximal seal into Zone 2 while enabling LSA incorporation. Recent literature has reinforced its promising results across different clinical scenarios. This article outlines the technical considerations of the Gore TBE^® and provides a contemporary narrative review of its clinical outcomes.