Off-the-shelf multibranched endograft for total endovascular repair of the aortic arch

Côme Bosse; Tilo Kölbel; Justine Mougin; Jarin Kratzberg; Dominique Fabre; Stéphan Haulon

doi:10.1016/j.jvs.2019.11.046

Off-the-shelf multibranched endograft for total endovascular repair of the aortic arch

J Vasc Surg. 2020 Sep;72(3):805-811. doi: 10.1016/j.jvs.2019.11.046. Epub 2020 Mar 6.

Authors

Côme Bosse¹, Tilo Kölbel², Justine Mougin¹, Jarin Kratzberg³, Dominique Fabre¹, Stéphan Haulon⁴

Affiliations

¹ Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, INSERM UMR_S999, Université Paris Saclay, Le Plessis-Robinson, France.
² Department of Vascular Medicine, German Aortic Centre Hamburg, University Cardiovascular Centre Hamburg, Hamburg, Germany.
³ Cook Medical, Bloomington, Ind.
⁴ Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, INSERM UMR_S999, Université Paris Saclay, Le Plessis-Robinson, France. Electronic address: s.haulon@hml.fr.

PMID: 32151480
DOI: 10.1016/j.jvs.2019.11.046

Abstract

Objective: The goal of this study was to select branched endograft designs that could fit most aortic arch anatomies. Such off-the-shelf endografts, once available, would be an endovascular therapeutic option to consider in the acute setting and would shorten the design and manufacturing process.

Methods: We retrospectively analyzed the endograft plans of all custom-made aortic arch branched endografts implanted between 2013 and early 2018 provided by the Cook Planning Center (EMEA Planning Services; Cook Medical, London, United Kingdom). Available data points of the endograft plans include proximal, intermediate, and distal endograft diameters; number of sealing stents; total length of the endograft; and number of branches.

Results: There were 286 two-branch endografts analyzed. We divided the endografts in three groups according to their proximal diameters: 34 mm, 36 mm, and 38 mm (group 1); 40 mm and 42 mm (group 2); and 44 mm and 46 mm (group 3). In group 1, 63% of the endografts had one proximal sealing stent, whereas in group 3, 63% had two proximal sealing stents. The distal diameters of the endografts ranged from 26 mm to 46 mm. The mean length was 236 mm (186-256 mm). A shorter standardized length of 211 mm was selected to anticipate distal extensions. According to our analysis, most group 1 patients could have been treated with a 38-mm proximal diameter and 30-mm distal diameter endograft with one sealing stent; most group 2 patients, with a 42-mm proximal diameter and 32-mm distal diameter endograft with both one and two proximal sealing stents; and most group 3 patients, with a 46-mm proximal diameter and 36-mm distal diameter endograft, also with both one and two proximal sealing stents.

Conclusions: Five standardized off-the-shelf endografts can cover a majority of aortic arch anatomies and offer an option for acute endovascular treatment of aortic arch disease.

Keywords: Acute arch disease; Aortic arch; Branched endograft; Off-the-shelf.

Publication types

Multicenter Study

MeSH terms

Aorta, Thoracic / diagnostic imaging
Aorta, Thoracic / surgery*
Aortic Diseases / diagnostic imaging
Aortic Diseases / surgery*
Blood Vessel Prosthesis Implantation / adverse effects
Blood Vessel Prosthesis Implantation / instrumentation*
Blood Vessel Prosthesis*
Humans
Prosthesis Design
Retrospective Studies
Stents*
Treatment Outcome