Thoracoabdominal aortic aneurysms (TAAA) are treated mainly endovascularly. Fenestrated or outer branched stentgrafts are often used for this purpose. More recently, new designed stentgrafts with inner branches are available. These stentgrafts have certain advantages. Aim of this study was to analyze the technical success rate and short-term results of inner branched endovascular aortic repair (iBEAVR).

All patients treated with an iBEVAR at a single center from January 2020 until December 2021 were reviewed. Patient characteristics, indications and targeted vessels were recorded. Procedural detail, outcomes and reintervention rate were analyzed.

Out of the total number of 115 EVAR procedures we performed 5 iBEVAR. Three patients showed Crawford Type III and one patient Crawford Type I TAAA. One patient was treated due to IA endoleak after EVAR of a juxtarenal abdominal aneurysm. Four E-xtra DESIGN ENGINEERING Jotec stentgrafts and one E-inside Jotec stentgraft were used. A total of 17 visceral arteries (3 TC, 5 AMS, 4 LRA, 4 RRA, 1 accessory LRA) were targeted with inner branches. Six visceral arteries with upwards facing and eleven with downwards facing inner branches. Bridging stentgrafts were Gore VIABAHN Balloon Expandable (n=15) and Bentley BeGraft+ (n=2). Two patients needed only percutaneous femoral access. Three patients had additionally cut down for the left axillar artery. All 17 visceral arteries were patent in the first postoperative CT scan. Follow up CT scan after three months were available for four patients and after one year for two patients. All inner branches were still patent. In one patient an IA endoleak disappeared completely during follow-up. One IB endoleak needed re-intervention after 3 months due to aneurysm sac growth. The remaining patients showed stable aneurysm sac in follow up.

Early results of iBEAVR are promising. We observed high patency rates of the bridging stentgrafts and reasonable reintervention rate. The inner branches gave us significantly more options for anatomically difficult conditions. Furthermore, the capability to treat complex TAAA with only femoral access decreases some perioperative risks. In addition, the off-the-shelf E-inside Jotec stentgraft can also be used to exclude emergent aneurysm. iBEVAR gives an additional armamentarium in endovascular treatment of difficult anatomy.