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Target vessel and Mid-term Outcomes after Endovascular Repair of Complex Abdominal and Type IV Thoracoabdominal Aortic Aneurysms using TAMBE vs t-Branch Devices
Andres V. Figueroa, Natalia I. Coronel, Marilisa Soto-Gonzalez,
Jesus H. Porras-Colon, Mirza S. Baig, Melissa L. Kirkwood, Carlos H. Timaran
University of Texas Southwestern Dallas, Dallas, TX
INTRODUCTION: Despite recent approval of an off-the-shelf device in the U.S. for complex abdominal and type IV thoracoabdominal aortic aneurysms (TAAAs), early target branch failures during the pivotal trial restricted its indication for primarily high-risk patients. This study aims to assess outcomes of off-the-shelf branched company-manufactured devices for treating such aneurysms.
METHODS: A single-center retrospective study of consecutive patients treated between 2017 and 2024 for complex abdominal and type IV TAAAs with the GORE ® EXCLUDER ® Thoracoabdominal Branch Endoprosthesis (TAMBE) and the Zenith ® t-Branch ® Thoracoabdominal Endovascular Graft (t-Branch) was performed. Endpoints included target vessel patency, freedom from secondary intervention, and target vessel instability (TVI).
RESULTS: A total of 44 patients (82% male, mean age 75 ± 7.6 years) were treated for 12 (27%) complex abdominal and 32 (73%) type IV TAAAs using off-the-shelf branched devices (Table). TAMBE and t-branch devices were used in 17 (38%) and 27 (62%) patients, respectively. Technical success was 100%. There were two 30-day deaths, one in the TAMBE cohort of unknown cause and one in the t-Branch cohort secondary to gastrointestinal bleeding. Patient survival at 1, 3, and 5 years was 82.5%, 58%, and 50%, respectively. There were no aortic-related deaths at a mean follow-up of 22±21 months (18±23 months in the TAMBE cohort vs. 22±20.5 months in the t-Branch cohort). Secondary interventions were required in 8 (47%) patients with TAMBE and 9 (33%) with t-Branch (
P= .52). Four target vessel occlusions and 5 stenoses occurred with TAMBE vs. 5 target vessel occlusions and 2 stenosis with t-Branch. Target vessel instability was significantly more frequent with TAMBE (freedom from TVI at 1, 3 and 5 years was 75%, 66%, and 66% with TAMBE vs. 93%, 87%, and 78% with t-Branch, respectively;
P=.007), primarily because of target vessel occlusions (freedom from target vessel occlusion at 1, 3, and 5 years was 78%, 75%, and 75% with TAMBE vs. 96%, 93%, and 93% with t-Branch, respectively;
P=.001). A greater length of the renal bridging stenting was required with TAMBE ([RRA 95±35 mm
vs. 68±21 mm;
P=.008]; LRA [114±58 mm
vs. 74±26 mm;
P=.027]).
CONCLUSIONS: TAMBE and t-Branch devices are safe for treating complex abdominal and type IV TAAAs. Target vessel instability is a concern with off-the-shelf branched devices, particularly TAMBE, given the frequent target vessel occlusions and bridging stent stenoses, which may be related to a greater length of renal bridging stenting required with TAMBE.
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