Performance Analysis of a New Generation Balloon Expandable Covered Stent When used as Bridging Stent-Graft During Inner-Branched Complex Aortic Repair.

Introduction: Target visceral vessels (TVVs) management during complex aortic treatments remains a critical aspect in endoluminal procedures. Bridge stent-graft (BSG) stability is essential for ensuring the effectiveness and safety of these interventions. Aim of this study was to assess the performance of the Viabahn balloon expandable (VBX) when used as BSG in association with Artivion's inner-branched endografts.

Methods: All patients consecutively treated for complex aortic pathology with Artivion inner-branched devices were prospectively enrolled, and those receiving at least one VBX as BSG were included. Primary outcome included VBX-related technical success, reinterventions and freedom from target vessel instability. Cox-regression analysis was used to identify variables independently associated with TVVs instability.

Results: Fifty-four patients were included in the study cohort. The total number of target visceral arteries bridged with a VBX through an inner branch was 159. VBX-related technical success was 99.4% (158/159). Each stent-graft was successfully delivered and deployed as planned without any intraprocedural endoleak. The VBX-related patency rate was 98% at 30 days (156/159). Three TVVs occlusions were recorded at follow-up, all asymptomatic and not requiring revascularization. A further TVV-related instability event was documented at a four-month follow-up. The mean follow-up was 11.4 ± 9.3 months. Estimates of freedom from TVVs occlusions and instability at 30 months were 96.6 and 96.0%, respectively. Cox-regression found no variables significantly associated with TVVs instability.

Conclusion: The VBX stent-graft appears to be a safe and effective bridging option for inner-branched thoracoabdominal aortic repair. Although preliminary results are promising, larger studies with longer follow-up are needed to validate these findings.