Results of target vessels bridged with a combination of more than one stent-graft in branched endovascular aneurysm repair of thoracoabdominal aortic aneurysms

BACKGROUND: This study aims to report the results of target vessels (TVs) bridged with more than one bridging stent-graft (BSG) in branched endovascular aneurysm repair (BEVAR) and assess the impact of hybrid configuration, BSG selection and relining on the outcomes. METHODS: Retrospective bicentric study including patients undergoing BEVAR for TAAA between January 2010-November 2025. Primary endpoints included primary patency and BSG-related endoleaks, reinterventions and target vessel instability (TVI). Endpoints were compared between TVs with one or more BSG, with or without hybrid configuration (balloon expandable stent-graft [BESG] + self-expandable stent-graft [SESG]), and with or without relining. A subanalysis in the subset of renal arteries (RAs) was also performed. RESULTS: Four hundred fifteen patients with 1081 vessels targeted with branches were included. 922 (85%) TVs were stented with one BSG and 159 (15%) with more than one device. Of those 159 TVs, 34 (21%) had a hybrid BESG+SESG configuration. Relining was performed in 250 (23%) TVs. Median follow-up was 20 months (IQR 8-45). In RAs, TVs with hybrid configuration presented better primary patency (Breslow P=0.004) and better freedom from TVI (Breslow P=0.019). Cox regression confirmed the type of BSG as an independent risk factor for primary patency and TVI with hybrid configuration performing better than BESG and SESG alone. CONCLUSIONS: Hybrid BESG+SESG configuration presented better primary patency and TVI in RAs targeted with branches in our series. The use of relining or combinations of more than one BSG without hybrid configuration did not show any significant improvement in TV related outcomes.