An Overview of the Branched Endovascular Aortic Repair (EVAR) Spectrum

Describe the major types, indications, and anatomical considerations for each branched EVAR technique.

Background:

Standard EVAR is often inadequate for managing complex aortic aneurysms, particularly due to the proximity of visceral or arch vessels, and challenges in achieving a reliable seal. To address these limitations, various branched techniques have been developed to preserve vessel patency, including Fenestrated EVAR (FEVAR), Thoracoabdominal Multibranched Endografts (TAMBE), and in thoracic aortic aneurysms, the newly approved Thoracic Branch Endoprosthesis (TBE) device. This educational exhibit will provide a comprehensive review of the indications, anatomical considerations, and clinical applications of these advanced techniques.

Clinical Findings/Procedure Details:

This educational exhibit will:

1. Describe patient criteria suitable for each technique, focusing on aneurysm location, complexity, and risk factors, including considerations for juxtarenal, pararenal, and thoracoabdominal aneurysms.

2. Review of anatomical criteria such as neck length, vessel angulation, and diameter for successful deployment of branched and fenestrated devices, with emphasis on achieving adequate proximal and distal seals.

3. Overview of the newly approved TBE, its indications for thoracic aortic aneurysms, and its role in preserving subclavian and arch vessel patency.

4. Analyze the latest clinical data on FEVAR, TAMBE, and TBE, focusing on survival rates, endoleaks, stent migration, reintervention rates, and overall safety and efficacy in treating complex aortic aneurysms.

5. Discuss common complications such as endoleaks, stent migration, and thrombosis, with strategies for prevention and management.

6. Present case studies demonstrating preoperative imaging, device selection, and procedural decision-making, with examples of successful deployments and complication management.

7. Explore evolving endovascular techniques in complex aortic aneurysms.

Conclusion and/or Teaching Points:

Branched and parallel graft techniques have emerged as critical advancements in the management of complex aortic aneurysms, particularly for maintaining visceral vessel patency and achieving adequate seal. The careful selection of patients, precise anatomical measurements, and tailored procedural planning are essential to the successful deployment of devices such as FEVAR, TAMBE, and the newly approved TBE. Furthermore, understanding the potential complications, including endoleaks and stent migration, and employing appropriate management strategies are vital to optimizing long-term results.