title: Applicability and midterm results of branch cuff closure with vascular plug in branched endovascular repair for thoracoabdominal aortic aneurysms.
abstract: This study assessed the applicability and outcomes of the closure of unused cuffs in branched endovascular aneurysm repair (b-EVAR) of thoracoabdominal aortic aneurysm.
  
  
  
  We reviewed b-EVAR procedures at a tertiary referral center to identify patients who underwent incomplete branching and needed closure of the unused branch cuffs. An electronic database and intraoperative and follow-up imaging studies were reviewed to assess technical applicability and outcomes.
  
  
  
  Between January 2007 and December 2015, 17 patients underwent incomplete branching during b-EVAR. The unused branch cuff in one patient occluded spontaneously after b-EVAR and was excluded from this analysis. The remaining 16 patients underwent 11 elective and five emergency repairs. Amplatzer Vascular Plugs (St. Jude Medical, Plymouth, Minn) were used to successfully close 17 branches: 8 targeting preoperatively occluded target vessels, 3 optional branches where fenestrations were used instead, 5 after failures of catheterization or stent bridging to target vessels, and 1 renal branch of an atrophic kidney. Four branch cuffs were extended with a peripheral covered stent before plug deployment. Sixteen branch cuffs were closed intraoperatively, and the remaining cuff was closed percutaneously at a later occasion. Perioperative death occurred in two patients. Median follow-up duration was 19 months (interquartile range, 11-30 months). There was no endoleak or reintervention related to the plugged cuffs. Two late deaths occurred not related to the aneurysm. Two patients required reinterventions for type III endoleaks with interval sac expansions caused by aortic stent graft component separation in tortuous thoracic segments not related to the occluded cuffs.
  
  
  
  Closure of the branch cuff of multibranched stent graft with Amplatzer Vascular Plug is feasible and effective. It was not associated with adverse aneurysm outcomes, and it is very useful especially when using an off-the-shelf device in the acute setting.
authors.affiliation: Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skåne University Hospital, Malmö, Sweden; Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: kiattisak.hongku@gmail.com.
authors.forename: Kiattisak
authors.initials: K
authors.lastname: Hongku
authors.affiliation: Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Timothy
authors.initials: T
authors.lastname: Resch
authors.affiliation: Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Sonesson
authors.affiliation: Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Thorarinn
authors.initials: T
authors.lastname: Kristmundsson
authors.affiliation: Department of Thoracic Surgery and Vascular Diseases, Vascular Center, Skåne University Hospital, Malmö, Sweden.
authors.forename: Nuno V
authors.initials: NV
authors.lastname: Dias
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D000072226:Computed Tomography Angiography; D057867:Endoleak / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D015607:Stents; D013548:Sweden; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D065506:Vascular Closure Devices