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Page 6 of 15 Rodrigues et al. Vessel Plus 2024;8:10 https://dx.doi.org/10.20517/2574-1209.2023.109

Table 1. Main characteristics of available or on trial endografts used for FB-EVAR based on their IFU
ZFEN TAMBE T-branch
Availability Available on market On trial On trial
Type of device Patient-specific Off-the-shelf Off-the-shelf
Indication Short neck and Juxta-renal AAA TAAA TAAA
Fenestration configuration Up to 03 fenestrations and 01 4 downward inner branches 4 downward
scallop branches
Minimal PLZ (mm) 4 20 25
PLZ diameter (mm) 19-31 mm 22-34 mm (if TAMBE alone) 24-30
19.5-32 mm (if proximal stent
graft)
Minimal DLZ (mm) 30 10 -
DLZ diameter (mm) Ipsilateral: 9-21 8-25 -
Contralateral: 7-21
Aortic neck angle < 45° ≤ 60° < 90°
Delivery system size 20 or 22 Fr 22 Fr 22 Fr
Proximal graft diameters (mm) 24, 26, 28, 30, 32, 34, 36 31, 37 34
Distal graft diameter (mm) - 20 18
Ipsilateral distal graft diameters (mm) 12, 16, 20, 24 - -
Contralateral distal graft diamenters (mm) 12, 14, 16, 18, 20, 22, 24 - -
Need for upper extremity access No Yes No
Upper extremity sheath size - 12 F -
Inner aortic diameter at the level of the visceral - ≥ 20 mm -
vessels’ origin

FB-EVAR: Fenestrated-branched endovascular aneurysm repair; IFU: instructions for use; AAA: abdominal aortic aneurysm; PLZ: proximal landing
zone; DLZ: distal landing zone.

incorporation of target arteries with directional branches presented fewer endoleaks and secondary
interventions compared to fenestrations with bridging stents when the distance between the endograft and
[40]
the target artery ostia was greater than 5 mm . This distance was also independently associated with an
increased risk of target artery instability. Even though directional branches are advantageous in certain
cases, such as larger aortic aneurysms in which directional cuffs are able to bridge the gap distance between
the stent-graft and the target vessel origin, they have demonstrated significantly lower primary and
secondary patency, particularly for renal artery, requiring parsimony in its use in patients with known
chronic kidney disease, solitary kidneys, or highly tortuous renal vessels [40,43,44] .

Tenorio et al., after examining 335 renal-mesenteric arteries targeted by directional branches, showed that
the renal artery patency following the incorporation by directional branches appears to be negatively
impacted compared to the patency of visceral arteries. Loss of primary patency was found to be associated
with renal artery targets as an independent predictor .
[45]

More recently, results from the United States Aortic Research Consortium (US ARC) revealed that
reinforced fenestrations are superior to directional branches in terms of primary and secondary target
patency rates, particularly for renal artery incorporation. Primary patency of mesenteric arteries targeted by
fenestrations did not differ from those incorporated by directional branches; nonetheless, secondary
patency was lower when directional branches were used. When it comes to target artery instability, the
study evidenced fewer overall events for vessels targeted using reinforced fenestrations compared to
[46]
directional branches, but reinforced fenestrations were related to higher rates of type IIIC endoleaks .