Anatomical Suitability of a Standard Subclavian Branched Endograft in Previous Zone 2 Thoracic Endovascular Aortic Repair

Purpose: To evaluate the anatomical suitability of the Gore Thoracic Branch Endoprosthesis in patients treated with thoracic endovascular aortic repair in landing zone 2. Materials and methods: A total of 517 cases were consecutively treated between 1999 and 2023, of which 102 were deployed in landing zone 2. A total of 92 patients were included in a single-center, retrospective, preclinical suitability study. The suitability for the investigational device was defined according to the manufacturer’s instructions for use. Extended suitability was also evaluated, including patients initially excluded for left subclavian artery measurements. Secondary outcomes were suitable and non-suitable patient comparisons, analysis of exclusion causes, and anatomical characteristics associated with suitability. A logistic regression model evaluated associations between baseline anatomical characteristics and non-suitability. Results: Seventy patients (76.1%) were suitable for implantation, which increased to 77 (83.6%) when analyzing extended suitability. Eighty-seven percent of suitable patients could have been treated with 5 aortic components, and 4 side branch configurations fitted 89.2% of suitable cases. A short prevertebral left subclavian artery length and a short proximal aortic landing zone were the most common causes of anatomical exclusion. The aortic landing zone diameter (odds ratio [OR]=0.83, 95% confidence interval [CI]=0.75–0.93, p=0.001) and length (OR=1.32, 95% CI=1.14–1.53, p<0.001) along with subclavian length (OR=1.18, 95% CI=1.07–1.31, p=0.001) were significantly associated with the odds of suitability. Conclusions: The Gore Thoracic Branch Endoprosthesis was anatomically suitable for more than 3 quarters of cases. A limited number of stent-graft configurations could fit the cohort in a remarkable number of patients, paving the way for wide application of this off-the-shelf device. Clinical Impact: The present paper highlighted a significant feasibility rate for the Gore Thoracic Branch Endoprothesis among patients previously treated with TEVAR and proximal landing in zone. The limited number of stent-graft configurations that could have been implanted in a considerable portion of our cohort could help clinicians to develop a proper endovascular inventory related to this device, paving the way for its wide application.