Early Experience With the Twin Branch in the Endovascular Treatment of Complex Aortic Aneurysms: A Multicenter Retrospective Study

Abstract

Objective:

This study aims to report on the early results of the twin branch as part of the Artivion E-xtra Design MultiBranch stent graft in the treatment of complex aortic aneurysms.

Methods:

We conducted a retrospective review of all implanted stent grafts containing a twin branch in 7 centers between March 2023 and March 2025. Outcomes of interest included baseline characteristics, technical success, twin branch–related events and short-term clinical and radiological outcomes.

Results:

Thirteen patients were identified and included. Mean age was 72.4 (±9.4) and mean aortic aneurysm diameter was 63.2 (±13.5). The indication for the twin branch was an early division of the celiac artery (CA) in 5 cases, a common ostium of the superior mesenteric artery (SMA) and CA in 3 cases, a large accessory renal artery in 3 cases, closely-originating chimneys in one and cannulation of the SMA and CA through an intimal entry tear in the last patient. Median follow-up was 4.4 (interquartile range: 2.3–7.4) months. Technical success was achieved in all cases; no mortality nor rupture occurred. There was 1 asymptomatic occlusion of an SMA stent graft incorporated into the twin branch at 11 weeks postoperatively. In this case, the twin branch bridging stents were inflated sequentially and not simultaneously. There was no twin branch–related endoleak.

Conclusion:

The twin branch is a feasible option in the treatment of complex aortic aneurysms with certain anatomic variations. Simultaneous inflation of both stent grafts should be performed to avoid compromising a previously-inflated stent graft.

Clinical Impact

The twin branch was developed as a component of the E-xtra Design MultiBranch stent graft system (Artivion, Hechingen, Germany). In this multicenter retrospective study, we demonstrate that the twin branch is a feasible option in the treatment of complex aortic aneurysms where a regular F/BEVAR is not possible because of the visceral vessels originating in close proximity to each other and where the aortic lumen is too narrow to allow for external branches. The short-term outcomes show a good technical success rate. Simultaneous insufflation of bridging stents might be beneficial to maintain target vessel patency..

Keywords

aortic aneurysm iBEVAR twin branch accessory renal artery common ostium

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