OFF-THE-SHELF COOK® T-BRANCH® BRANCHED ENDOPROSTHESIS DEPLOYMENT: TECHNICAL ASPECTS AND TIPS AND TRICKS

  • Alice Cabral Lopes Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Lisboa Norte; Lisboa; Portugal
  • Ryan Gouveia Melo Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Lisboa Norte; Lisboa; Portugal
  • Pedro Amorim Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Lisboa Norte; Lisboa; Portugal
  • Gonçalo Sobrinho Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Lisboa Norte; Lisboa; Portugal
  • Ruy Fernandes e Fernandes Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Lisboa Norte; Lisboa; Portugal
  • Luís Mendes Pedro Serviço de Angiologia e Cirurgia Vascular; Centro Hospitalar Lisboa Norte; Lisboa; Portugal
Keywords: Thoracoabdominal aneurysms, Endovascular treatment, Branched stentgraft, Off-the shelf device, Deployment technique

Abstract

Introduction: Off-the-shelf multi-branched stent grafts, such as Cook t-Branch®, emerged as an alternative for the prompt treatment of thoracoabdominal aneurysms (ATA).

Objective/Technique: In our institution, the use of the Cook T-Branch® stent graft has been carried out in urgent cases and in some elective cases with favorable anatomy and in which it is not advisable to wait for the production of a custom-made device (CMD). The accumulated experience justifies the purpose of this review article, which aims to describe the deployment, some adjuvant techniques and some tips and tricks that may facilitate the learning curve in centers with less contact with this platform.

Conclusion: The use of off-the-shelf multi-branched stent grafts, such as Cook T-Branch®, is a safe and viable alternative for the treatment of ATA. The main advantage of this approach is its prompt accessibility. As we advance in the learning curve and new adjuvant techniques are acquired, their applicability is significantly increased, both in the urgent and elective context.

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References

1. Tsilimparis N, Fiorucci B, Debus ES, Rohlffs F, Kölbel T. Technical Aspects of Implanting the t-Branch Off-the-Shelf Multibranched Stent-Graft for Thoracoabdominal Aneurysms. J Endovasc Ther. 2017;24(3):397-404. doi:10.1177/1526602817690730

2. Verhoeven E, Tielliu IF, Zeebregts CJ, et al. Results of endovascular repair of TAAA in the first 50 patients. Zentralbl Chir. 2011;136:451–457.

3. Greenberg R, Eagleton M, Mastracci T. Branched endografts for thoracoabdominal aneurysms. J Thorac Cardiovasc Surg. 2010;140(6 suppl):S171–S178.

4. Chuter TA. Fenestrated and branched stent-grafts for thoracoabdominal, pararenal and juxtarenal aortic aneurysm repair. Semin Vasc Surg. 2007;20:90–96.

5. Youssef M, Deglise S, Szopinski P, et al. A multicenter experience with a new fenestrated-branched device for endovascular repair of thoracoabdominal aortic aneurysms. J Endovasc Ther. 2018;25:209–219.

6. Georgiadis GS, van Herwaarden JA, Saengprakai W, et al. Endovascular treatment of complex abdominal and thoracoabdominal type IV aortic aneurysms with fenestrated technology. J Cardiovasc Surg (Torino). 2017;58:574–590.

7. Verzini F, Loschi D, De Rango P, et al. Current results of total endovascular repair of thoracoabdominal aortic aneurysms. J Cardiovasc Surg (Torino). 2014;55:9–19.

8. Mendes BC, Oderich GS, Macedo TA, et al. Anatomic feasibility of off-the-shelf fenestrated stent grafts to treat juxtarenal and pararenal abdominal aortic aneurysms. J Vasc Surg. 2014;60(4):839-848. doi:10.1016/j.jvs.2014.04.038

9. Azzaoui R, Sobocinski J, Maurel B, et al. Anatomic study of juxta renal aneurysms: impact on fenestrated stent-grafts. Ann Vasc Surg. 2011;25(3):315-321. doi:10.1016/j.avsg.2010.08.009

10. Sweet MP, Hiramoto JS, Park KH, Reilly LM, Chuter TA. A standardized multi-branched thoracoabdominal stent-graft for endovascular aneurysm repair. J Endovasc Ther. 2009;16(3):359-364. doi:10.1583/09-2734.1

11. Bisdas T, Donas KP, Bosiers M, et al. Anatomical suitability of the T-branch stent-graft in patients with thoracoabdominal aortic aneurysms treated using custom-made multibranched endografts. J Endovasc Ther. 2013;20:672–677.

12. Oderich GS, Mendes BC. Endovascular repair of thoracoabdominal aortic aneurysm using the off-the-shelf multibranched t-Branch stent graft. J Vasc Surg. 2016;63:1394–1399.e2.

13. Ferreira M, Ferreira D, Cunha R, Bicalho G, Rodrigues E. Advanced Technical Considerations for Implanting the t-Branch Off-the-Shelf Multibranched Stent-Graft to Treat Thoracoabdominal Aneurysms. J Endovasc Ther. 2018;25(4):450-455. doi:10.1177/1526602818779826

14. Fiorucci B, Kölbel T, Rohlffs F, et al. Right brachial access is safe for branched endovascular aneurysm repair in complex aortic disease. Journal of Vascular Surgery. 2017 Aug;66(2):360-366. DOI: 10.1016/j.jvs.2016.12.114.

15. Alvarez-Tostado JA, Moise MA, Bena JF, et al. The brachial artery: a critical access for endovascular procedures. J Vasc Surg. 2009;49:378–385.

16. Banga PV, Oderich GS, Reis de Souza L, Hofer J, Cazares Gonzalez ML, Pulido JN, et al. Neuromonitoring, Cerebrospinal fluid drainage, and selective use of iliofemoral conduits to minimize risk of spinal cord injury during complex endovascular aortic repair. J Endovasc Ther 2016;23:139-49.

17. Oderich GS, Mendes BC. (2017). Techniques of Implantation of Fenestrated and Multibranched Stent Grafts for Visceral Artery Incorporation. In G.S. Oderich (Ed), Endovascular Aortic Repair (pp.413-448). Rochester, MN
Published
2021-06-03
Section
Review Article