Inner Branched Complex Aortic Repair Outcomes from a National Multicenter Registry Using the E-xtra Design Platform (The CELER study)

The dualism between fenestrated and branched configurations for visceral artery revascularization during complex aortic repair is yet unsolved, with each approach having its own pros and cons. The inner branched technology (inner branched complex aortic repair [iBEVAR]) aims to take the best out of both strategies, offering wide applicability and stable bridging stent sealing. The objective of this study was to evaluate the early outcomes obtained with a single manufacturer, custom made, inner-branched endograft in a multicenter Italian experience. All patients consecutively treated with E-xtra (Jotec GmbH, Hechingen, Germany) devices in three high-volume Italian facilities were enrolled. The main objective was to assess technical and clinical success after iBEVAR. Secondary endpoints were early survival and target visceral vessel (TVV) patency during follow-up. From 2016 to 2021, forty-five patients were treated with an E-xtra design device, revascularizing at least one visceral vessel through an inner branch. The total number of TVVs to be bridged with an inner branch was 159. Technical success was achieved in 93.9% of the procedures (42/45), with all failures due to type I endoleak at final angiography. Each TVV was successfully connected to the graft’s main body as planned without complications. At 30 days, the secondary clinical success was 93.3% (42/45). No death, as well as no TVV thrombosis, occurred within 30 days from the primary procedures. Mean follow-up was 22.8 ± 14.2 months. Kaplan-Meier estimates of overall survival and TVV patency at 36 months were 83.9% and 95.9%, respectively. Inner branches seem to represent a competitive technology in the complex aortic repair landscape, with an applicability ranging from type II thoracoabdominal aneurysm to type I endoleak repair after infrarenal endografting. Whether iBEVAR could offer results comparable with those provided by F/BEVAR in term of target vessel patency and stent stability is yet to be established, and further studies will therefore be needed.