Midterm Outcomes of Endovascular Repair of Aortic Arch Aneurysms with the Gore Thoracic Branch Endoprosthesis

Published:August 12, 2022DOI:


      Aortic aneurysms involving aortic arch vessels are anatomically unsuitable for standard thoracic endovascular repair (TEVAR) without cervical debranching of the arch vessels. Three year outcomes of a single branched thoracic endograft following previous publication of peri-operative and one year outcomes are reported.


      This was a multicentre feasibility trial of the GORE TAG Thoracic Branch Endoprosthesis (TBE), a thoracic endovascular graft incorporating a single retrograde branch for aortic arch vessel perfusion. The first study arm enrolled patients with an intact descending thoracic aortic aneurysm extending to the distal arch with left subclavian artery (LSA) incorporation (zone 2). The second arm enrolled patients with arch aneurysms requiring incorporation of the left carotid or innominate artery (zone 0/1) and extra-anatomic surgical revascularisation of the remaining aortic arch vessels. Outcomes at three years are reported.


      The cohort comprised 40 patients (31 zone 2, nine zone 0/1). The majority were male (52%). Mean follow up was 1 408 ± 552 days in the zone 2 and 1 187 ± 766 days in the zone 0/1 cohort. During three year follow up there was no device migration, fracture, or aortic rupture in either arm. In the zone 2 arm, freedom from re-intervention was 97% at one and three years but there were two side branch occlusions. Two patients had aneurysm enlargement > 5 mm without documented endoleak or re-intervention. Freedom from death at one and three years was 90% and 84%. In the zone 0/1 arm there were no re-interventions, loss of branch patency, or aneurysm enlargement at three years. Cerebrovascular events occurred in three patients during follow up: two unrelated to the device or procedure, and one of unknown relationship. Two patients in this arm died during the follow up period, both unrelated to the procedure or the aneurysm.


      Initial three year results of the TBE device for endovascular repair of arch aneurysms show favourable patency and durability with low rates of graft related complications.


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        • Matsumura J.S.
        • Lee W.A.
        • Mitchell R.S.
        • Farber M.A.
        • Murad M.H.
        • Lumsden A.B.
        • et al.
        The Society for Vascular Surgery Practice Guidelines: management of the left subclavian artery with thoracic endovascular aortic repair.
        J Vasc Surg. 2009; 50: 1155-1158
        • Hiratzka L.F.
        • Bakris G.L.
        • Beckman J.A.
        • Bersin R.M.
        • Carr V.F.
        • Casey D.E.
        • et al.
        2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease.
        J Am Coll Cardiol. 2010; 55: e27-129
        • Gombert A.
        • van Issum L.
        • Barbati M.E.
        • Grommes J.
        • Keszei A.
        • Kotelis D.
        • et al.
        Extra-thoracic supra-aortic bypass surgery is safe in thoracic endovascular aortic repair and arterial occlusive disease treatment.
        Eur J Vasc Endovasc Surg. 2018; 55: 861-866
        • Czerny M.
        • Schmidli J.
        • Adler S.
        • van den Berg J.C.
        • Bertoglio L.
        • Carrel T.
        • et al.
        Editor’s Choice – Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery.
        Eur J Vasc Endovasc Surg. 2019; 57: 165-198
        • Chakos A.
        • Jbara D.
        • Yan T.D.
        • Tian D.H.
        Long-term survival and related outcomes for hybrid versus traditional arch repair-A meta-analysis.
        Ann Cardiothorac Surg. 2018; 7: 319-327
        • Patel H.J.
        • Dake M.D.
        • Bavaria J.E.
        • Singh M.J.
        • Filinger M.
        • Fischbein M.P.
        • et al.
        Branched endovascular therapy of the distal aortic arch: preliminary results of the feasibility multicenter trial of the gore thoracic branch endoprosthesis.
        Ann Thorac Surg. 2016; 102: 1190-1198
        • Dake M.D.
        • Bavaria J.E.
        • Singh M.J.
        • Oderich G.
        • Filinger M.
        • Fischbein M.P.
        • et al.
        Management of arch aneurysms with a single-branch thoracic endograft in zone 0.
        JTCVS Tech. 2021; 7: 1-6
        • Dake M.D.
        • Fischbein M.P.
        • Bavaria J.E.
        • Desai N.D.
        • Oderich G.
        • Singh M.J.
        • et al.
        Evaluation of the Gore TAG thoracic branch endoprosthesis in the treatment of proximal descending thoracic aortic aneurysms.
        J Vasc Surg. 2021; 74: 1483-1490
        • Tsilimparis N.
        • Detter C.
        • Law Y.
        • Rohlffs F.
        • Heidemann F.
        • Brickwedel J.
        • et al.
        Single-center experience with an inner branched arch endograft.
        J Vasc Surg. 2019; 69: 977-985
        • Tenorio E.R.
        • Oderich G.S.
        • Kölbel T.
        • Dias N v
        • Sonesson B.
        • Karelis A.
        • et al.
        Multicenter global early feasibility study to evaluate total endovascular arch repair using three-vessel inner branch stent-grafts for aneurysms and dissections.
        J Vasc Surg. 2021; 74: 1055-1065
        • Ferrer C.
        • Cao P.
        Endovascular arch replacement with a dual branched endoprosthesis.
        Ann Cardiothorac Surg. 2018; 7: 366-371
        • Czerny M.
        • Berger T.
        • Kondov S.
        • Siepe M.
        • saint Lebes B.
        • Mokrane F.
        • et al.
        Results of endovascular aortic arch repair using the Relay Branch system.
        Eur J Cardio-Thoracic Surg. 2021; 60: 662-668
        • Haulon S.
        • Greenberg R.K.
        • Spear R.
        • Eagleton M.
        • Abraham C.
        • Lioupis C.
        • et al.
        Global experience with an inner branched arch endograft.
        J Thorac Cardiovasc Surg. 2014; 148: 1709-1716
        • Iwakoshi S.
        • Ichihashi S.
        • Itoh H.
        • Tabayashi N.
        • Sakaguchi S.
        • Yoshida T.
        • et al.
        Clinical outcomes of thoracic endovascular aneurysm repair using commercially available fenestrated stent graft (Najuta endograft).
        J Vasc Surg. 2015; 62: 1473-1478
        • Azuma T.
        • Yokoi Y.
        • Yamazaki K.
        The next generation of fenestrated endografts: results of a clinical trial to support an expanded indication for aortic arch aneurysm treatment.
        Eur J Cardiothoracic Surg. 2013; 44: 156-164
        • Roselli E.E.
        • Arko F.R.
        • Thompson M.M.
        Results of the Valiant Mona LSA early feasibility study for descending thoracic aneurysms.
        J Vasc Surg. 2015; 62: 1465-1471
        • Voskresensky I.
        • Scali S.T.
        • Feezor R.J.
        • Fatima J.
        • Giles K.A.
        • Tricarico R.
        • et al.
        Outcomes of thoracic endovascular aortic repair using aortic arch chimney stents in high-risk patients.
        J Vasc Surg. 2017; 66: 9-20
        • Redlinger R.E.
        • Ahanchi S.S.
        • Panneton J.M.
        In situ laser fenestration during emergent thoracic endovascular aortic repair is an effective method for left subclavian artery revascularization.
        J Vasc Surg. 2013; 58: 1171-1177
        • Tse L.W.
        • Lindsay T.F.
        • Roche-Nagle G.
        • Oreopoulos G.D.
        • Ouzounian M.
        • Tan K.T.
        Radiofrequency in situ fenestration for aortic arch vessels during thoracic endovascular repair.
        J Endovasc Ther. 2015; 22: 116-121
        • Mandigers T.J.
        • de Beaufort H.W.L.
        • Smeenk H.G.
        • Vos J.A.
        • Heijmen R.H.
        Long-term patency of surgical left subclavian artery revascularization.
        J Vasc Surg. 2022; 75: 1977-1984