The aim of this study was to report the outcomes of different preloaded systems that involve catheters and wires of fenestrations and branches to facilitate access to target vessel arteries during endovascular repair of complex aortic aneurysms.

This was an observational retrospective cohort single center study. Patients were treated with fenestrated and branched aortic endografts for complex abdominal and thoraco-abdominal aortic aneurysms (TAAAs) between 2015 and 2022. Patients were grouped into six groups based on the type of preloaded system used and included the standard endograft (SG) group, thoraco-abdominal low profile delivery system (TPLP), thoraco-abdominal preloaded delivery system (TPDS), single preloaded guidewire/ thoraco-abdominal preloaded through-through wire (TPTT), modified preloaded delivery system (MPDS) and preloaded delivery system (PDS) (Figure). Technical success was defined as successful intra-operative catheterization and stenting of all intended target visceral arteries. ANOVA and Chi-square tests were performed to identify differences in outcomes between repairs using preloaded and standard devices

306 patients (71% men, mean age 73 ± 11 years) treated for 32 juxtarenal (10%) and 82 (27%) suprarenal complex abdominal aneurysms, 42 (14 %) extent IV TAAAs and 61 (20%)extent I - III TAAAs. Preloaded grafts (PGs) were used in 214 (71 %) patients and standard grafts (SGs) in 92 (29 %). TPTT was used in 39 (13%), TPDS in 95 (31 %), TPLP in 29 (9 %), MPDS in 39 (13 %) and PDS in 12 (4%). PGs were used preferentially for suprarenal aneurysms (43% vrs 14; P = .09). A total of 616 device components were specifically preloaded (mean 2.0/patient), including 343 fenestrations from above (56%), 143 fenestrations from below (23%), 120 branches from above (21%), 8 branches from below (1.2%) and 2 scallops one from above and another one from below (0.3%). Most preloaded grafts (PG) included fenestrations from above (57% vs 43%). Upper extremity access was more frequent for PGs (81% vs. 60%; P < .001). Procedure time, fluoroscopy time, and technical success were not significantly different between preloaded and standard devices. Overall technical success was 98% and comparable for both preloaded and standard grafts (98% vs. 98%; P = .09). The single preloaded guidewire /TPTT system was associated with a significantly lower main device french size and less radiation in comparison with the rest of preloaded systems and SG (P < .001) (Table). The 30-day stroke rate was lower for PGs than SGs (1.4% and 3.3%, P = .053).

Use of preloaded catheters and wires for fenestrations and directional branches was associated with high technical success and lower stroke rates compared to SGs. The single guidewire/TPTT preloaded system allows a significantly lower device profile than other preloaded systems. Because of its simplicity, lower profile and the ability to switch from upper to exclusive transfemoral access, the single guidewire/TPTT preloaded system has become our preferred current preloaded system.