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Ann Thorac Surg. 2016 Oct;102(4):1190-8. doi: 10.1016/j.athoracsur.2016.03.091. Epub 2016 Jun 2.

Branched Endovascular Therapy of the Distal Aortic Arch: Preliminary Results of the Feasibility Multicenter Trial of the Gore Thoracic Branch Endoprosthesis.

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Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan. Electronic address:
Department of Cardiothoracic Surgery, Stanford University Hospitals, Palo Alto, California.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Department of Radiology, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan.
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Surgery, Mayo Clinic, Rochester, Minnesota.



Endovascular treatment for aortic arch aneurysms often requires adjunctive use of hybrid debranching procedures to maintain branch vessel perfusion. This study describes early results with a novel branched arch endograft for total endovascular repair of distal arch aneurysms.


This US feasibility multicenter clinical trial evaluated 22 patients (mean age, 74.1 ± 10.5 years; 54.5% male) undergoing branched thoracic endovascular aortic repair in Ishimaru zone 2. This endograft was designed with a single side branch designed to facilitate aortic coverage proximal to the left subclavian artery while maintaining branch vessel patency. The pathologic features treated included fusiform (n = 10) and saccular (n = 12) aneurysms, with a mean aortic diameter of 5.7 ± 1.1 cm. The mean preoperative left-to-right brachial index was 1.0 ± 0.1.


The mean total treatment length was 17.6 ± 8.9 cm; 8 patients were treated with a single 10-cm graft for isolated arch disease. The primary endpoint of device delivery and branch vessel patency was achieved in 100% of patients, without 30-day death, stroke, or permanent paraplegia. The median duration of hospitalization was 4.0 days. Type I endoleaks at completion angiography were observed in 4 patients, and all resolved by 1 month without reintervention. All side branches were patent at 1 month. The Kaplan-Meier survival rate at 6 months was 94.7%.


Total endovascular repair of distal zone 2 arch aortic aneurysms can be achieved with a novel branched arch endograft. Future studies will evaluate the feasibility of this approach for aneurysms encompassing the brachiocephalic trunk and left carotid artery.

[Indexed for MEDLINE]

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