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Background <p>Thoracic endovascular aortic repair (TEVAR) with branch reconstruction is an alternative to open surgery for aortic arch pathologies. However, mid-term data comparing different strategies are limited. This study aimed to evaluate the mid-term outcomes of single- and double-branch TEVAR and analyze the performance of different single-branch reconstruction techniques.</p> Methods <p>We retrospectively analyzed 198 consecutive patients who underwent TEVAR for aortic arch lesions with either single-branch (<i>n</i> = 169) or double-branch (<i>n</i> = 29) reconstruction at a single center between February 2015 and December 2023. The primary endpoint was the mid-term all-cause mortality. The secondary endpoints included technical success, perioperative safety, aorta-related complications, and reintervention rates. Kaplan-Meier survival analysis, multivariable Cox regression, and Restricted Mean Survival Time (RMST) analysis were performed. The influence of age was explored using Restricted Cubic Splines (RCS), modeling age continuously.</p> Results <p>The overall technical success rate was 96.0%. The mean follow-up duration was 40.5 months. There was no significant difference in mid-term all-cause mortality between the single- and double-branch groups (Log-rank <i>P</i> = 0.710). Multivariable Cox regression identified older age as an independent predictor of mortality (HR 1.047 per year, 95% CI 1.012–1.084, <i>P</i> = 0.009) but not the number of branches reconstructed (<i>P</i> = 0.611). Among the single-branch techniques, RMST analysis confirmed no significant difference in mid-term survival (all pairwise <i>P</i> &gt; 0.050). An inverse association between age and aorta-related complications was suggested (OR 0.957, 95% CI 0.923–0.993, <i>P</i> = 0.020), which most plausibly reflects selection bias and warrants confirmation in larger, multicenter studies.</p> Conclusion <p>In this single-center cohort study, single- and double-branch TEVAR yielded no statistically significant difference in mid-term survival. Age, and not the number of reconstructed branches, was the primary predictor of mortality. All single-branch techniques showed comparable mid-term survival, supporting an individualized, anatomy-driven approach. The observed inverse association between age and aorta-related complications highlights the critical role of patient selection in these complex procedures and warrants confirmation in larger, multicenter studies with standardized anatomical assessment and imaging follow-up.</p>

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Anatomy-driven strategies and mid-term outcomes of branched endovascular repair of the aortic arch: a single-center cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月9日

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  • Bin Zhao,
  • Zongwei Liu,
  • Hao Liang,
  • Jiaxue Bi,
  • Xiangchen Dai

摘要

Background

Thoracic endovascular aortic repair (TEVAR) with branch reconstruction is an alternative to open surgery for aortic arch pathologies. However, mid-term data comparing different strategies are limited. This study aimed to evaluate the mid-term outcomes of single- and double-branch TEVAR and analyze the performance of different single-branch reconstruction techniques.

Methods

We retrospectively analyzed 198 consecutive patients who underwent TEVAR for aortic arch lesions with either single-branch (n = 169) or double-branch (n = 29) reconstruction at a single center between February 2015 and December 2023. The primary endpoint was the mid-term all-cause mortality. The secondary endpoints included technical success, perioperative safety, aorta-related complications, and reintervention rates. Kaplan-Meier survival analysis, multivariable Cox regression, and Restricted Mean Survival Time (RMST) analysis were performed. The influence of age was explored using Restricted Cubic Splines (RCS), modeling age continuously.

Results

The overall technical success rate was 96.0%. The mean follow-up duration was 40.5 months. There was no significant difference in mid-term all-cause mortality between the single- and double-branch groups (Log-rank P = 0.710). Multivariable Cox regression identified older age as an independent predictor of mortality (HR 1.047 per year, 95% CI 1.012–1.084, P = 0.009) but not the number of branches reconstructed (P = 0.611). Among the single-branch techniques, RMST analysis confirmed no significant difference in mid-term survival (all pairwise P > 0.050). An inverse association between age and aorta-related complications was suggested (OR 0.957, 95% CI 0.923–0.993, P = 0.020), which most plausibly reflects selection bias and warrants confirmation in larger, multicenter studies.

Conclusion

In this single-center cohort study, single- and double-branch TEVAR yielded no statistically significant difference in mid-term survival. Age, and not the number of reconstructed branches, was the primary predictor of mortality. All single-branch techniques showed comparable mid-term survival, supporting an individualized, anatomy-driven approach. The observed inverse association between age and aorta-related complications highlights the critical role of patient selection in these complex procedures and warrants confirmation in larger, multicenter studies with standardized anatomical assessment and imaging follow-up.