Outcomes of Retrograde Branches in Patients Treated for Complex Aortic Aneurysms Using Patient Specific Company Manufactured or Physician Modified Endografts

OBJECTIVE: Retrograde branches have been used during complex endovascular aortic repair, but their outcomes have not been reported. This study evaluated the retrograde branch performance for renovisceral and other aortic side branches at 30 days and during follow up. METHODS: A multicentre retrospective study (Universität Regensburg; Protocol: 24-3786-101) was conducted according to Strengthening the Reporting of Observational Studies in Epidemiology guidelines among centres in Europe, the USA, and New Zealand encompassing patients managed from 1 January 2013 to 31 January 2025. Consecutive patients with thoraco-abdominal and complex abdominal aortic pathologies managed with patient specific company manufactured devices (CMDs) or physician modified endografts (PMEGs) incorporating at least one retrograde branch were included. Technical success, 30 day primary patency, target vessel instability, and re-intervention were analysed. Follow up outcomes were assessed (Kaplan-Meier estimates). RESULTS: A total of 146 patients were included (72.6% men; age 70.6 ± 2.0 years); 25.3% were managed urgently. Twenty one (14.4%) aneurysms were juxtarenal, 14 (9.6%) were pararenal, and 111 (76.0%) were thoraco-abdominal (38 [26.0%] chronic dissections). One hundred and nine (74.7%) CMDs and 37 PMEGs were implanted, with 575 target vessels; 176 were targeted through a retrograde branch (nine superior mesenteric arteries, 25 coeliac trunks, 118 renal arteries, and 24 other side branches). One hundred (56.8%) of these vessels were bridged with balloon expandable, 46 (26.1%) with self expanding, and 27 (18.5%) with a combination of both covered stent types. The retrograde branch associated technical success was 97.7%. The 30 day primary patency was 97.7% and the re-intervention rate was 1.7%. The mean follow up duration was 21.5 ± 4.8 months. The primary patency and freedom from instability were 81.0 ± 5.7% and 78.2 ± 5.7% at 48 months. The freedom from re-intervention was 92.9 ± 2.5% at 12 months, without further re-intervention during follow up. There was no difference between 6 mm and 8 mm branches or between CMDs and. PMEGs. CONCLUSION: Retrograde branches for bridging well selected renovisceral arteries and other aortic side branches were related to high technical success and good patency during midterm follow up.