Factors Affecting the Visceral Suitability of a Multibranched off-the-Shelf Endograft for the Treatment of Thoraco-Abdominal Aortic Aneurysms

Mazzaccaro D, Avishay D, Nano G. Factors Affecting the Visceral Suitability of a Multibranched off-the-Shelf Endograft for the Treatment of Thoraco-Abdominal Aortic Aneurysms. Ann Vasc Surg. 2022 Apr;81:113-120. doi: 10.1016/j.avsg.2021.08.053. Epub 2021 Nov 4. PMID: 34743010. Abstract Background: To assess the factors affecting visceral suitability of the use of the Zenith T-branch^TM system in a group of patients with thoraco-adbominal aortic aneurysms (TAAAs). Methods: Computer tomography angiography (CTA) of patients who presented a TAAA from 01/2015 to 12/2019 were retrospectively examined. Multi-Planar Reconstructions were performed on CTA images to assess the anatomic suitability of the Zenith T-branch in the visceral district. In particular, the branch deviation angle (BDA), and the branch-length were computed for each target vessel. Results: Fifty-four CTA were examined. In 33.3% of these patients the presence of either a common origin of the superior mesenteric artery and the celiac trunk, or the diameter of 1 or more visceral/renal artery limited the visceral suitability of the device. All patients except 1 (97.9%) fitted the BDA criterion when the graft was placed in a position in which the BDA for the SMA was 5 degrees to the left. The branch-length criteria was met in all patients, except for 1 (97.9%), when the graft was placed in the center of the aorta. The eccentrical placement of the endograft decreased the suitability to 93.7%. Conclusions: The Zenith T-branch system can be suitable in the visceral district for about 67% of patients. The target artery diameter was the most limiting criterion. The central location of the graft within the aortic lumen significantly affected the branch-length distance criteria.