Inner Branch Endografts for the Treatment of Complex Abdominal Aortic Aneurysms, Off-the-Shelf and Custom-Made Presentation

Endovascular treatment options for large complex aortic aneurysms that intervention remain limited and often patient comorbidities make open surgery unappealing. Our aim is to compare aspects regarding patient selection, planning and implantation technique for the off-the-sell inner branch E-Nside (Jotec GmbH, Hechingen, Germany) with the custom-made Extra-Design (Artivion, Kennesaw, GA). E-Nside is a new off-the-shelf endograft with four precannulated inner branches that has recently become available in Europe. We report and describe the treatment of six large complex aortic aneurysms using E-nside, and five patients treated with Extra-Design, and discuss the benefits of the selection. The E-Nside comes in four different versions with proximal diameters of 33 mm and 38 mm and distal diameters of 26 mm and 30 mm. All four inner branches are located in the middle segment, which has a diameter of 24 mm. The precannulation of branches provides consistent access and a readily available option for establishment of a through-and-through wire. The total length is 222 mm. The Extra-Design is tailored to the patient's anatomy, with the possibility of including from two to five inner or outer branches. Our five endografts had four inner branches. In our cohort, total aortic coverage was 393.6 mm in the E-Nside group and 221.2 in the Extra Design group (P = .016). We used 76 minutes of fluoroscopy time in both groups; radiation exposure was 359 Gy·cm2 in the off-the-shelf implants, and 392 Gy·cm2 in the custom-made device implants (P = .8). Both endografts with inner branches are useful tools for the treatment of complex aortic aneurysms. The off-the-shell E-Nside device is the best option for emergent patients with easy access to the branches. In our cases, the established through-and-through wire added stability in tortuous anatomy in the E-Nside implants, while the Extra Design allowed for more limited aortic coverage.