{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T01:55:46Z","timestamp":1790128546218,"version":"4.0.1"},"reference-count":44,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objective: Bridging stent optimal choice in fenestrated and branched endovascular aortic repair (f\/bEVAR) is under investigation. This systematic review and meta-analysis studied the outcomes of the BeGraft peripheral and peripheral PLUS as bridging stents in f\/bEVAR. Methods: The methodology was pre-registered to the PROSPERO (CRD420251007695). Following the PRISMA guidelines and PICO model, the PubMed, Cochrane and Embase databases were searched for observational studies and randomized control trials, in English, from 2015 to 2025, reporting on f\/bEVAR patients using the second-generation BeGraft peripheral or the BeGraft peripheral PLUS balloon expandable covered stent (BECS; Bentley InnoMed, Hechingen, Germany) for bridging. The ROBINS-I assessed the risk of bias and GRADE the quality of evidence. Target vessel technical success, occlusion\/stenosis, endoleak Ic\/IIIc, reintervention and instability during follow-up were primary outcomes, assessed using proportional meta-analysis. Results: Among 1266 studies, eight were included (1986 target vessels; 1791 bridged via BeGraft); all retrospective, except one. The ROBINS-I showed that seven were at serious risk of bias. According to GRADE, the quality of evidence was \u201cvery low\u201d for primary outcomes. Target vessel technical success was 99% (95% CI 98\u2013100%; I2 = 12%). The mean follow-up was 20.2 months. Target-vessel instability was 3% (95% CI 2\u20135%; I2 = 44%), occlusion\/stenosis was 1% (95% CI 1\u20134%; I2 = 8%) and endoleak Ic\/IIIc was 1% (95% CI 0\u20133%; I2 = 0%). The estimated target-vessel reintervention was 2% (95% CI 2\u20134%; I2 = 12%). Celiac trunk, superior mesenteric and renal artery instability were 1% (95% CI 0\u201316%; I2 = 0%;), 1% (95% CI 0\u20135%; I2 = 14%) and 4% (95% CI 2\u20137%; I2 = 40%), respectively. Conclusions: The BeGraft peripheral and peripheral PLUS BECS performed with high technical success and low instability when used for bridging in f\/bEVAR. Cautious interpretation is required due to the very low quality of evidence.<\/jats:p>","DOI":"10.3390\/jcm14155221","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T14:22:44Z","timestamp":1753280564000},"page":"5221","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Systematic Review and Meta-Analysis on the BeGraft Peripheral and BeGraft Peripheral PLUS Outcomes as Bridging Covered Stents in Fenestrated and Branched Endovascular Aortic Repair"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5431-3842","authenticated-orcid":false,"given":"George","family":"Apostolidis","sequence":"first","affiliation":[{"name":"German Aortic Centre, Department of Vascular Medicine, University Medical Center Eppendorf, 20251 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9060-8519","authenticated-orcid":false,"given":"Petroula","family":"Nana","sequence":"additional","affiliation":[{"name":"German Aortic Centre, Department of Vascular Medicine, University Medical Center Eppendorf, 20251 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 I.","family":"Torrealba","sequence":"additional","affiliation":[{"name":"German Aortic Centre, Department of Vascular Medicine, University Medical Center Eppendorf, 20251 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Panuccio","sequence":"additional","affiliation":[{"name":"German Aortic Centre, Department of Vascular Medicine, University Medical Center Eppendorf, 20251 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Katsargyris","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, General Hospital Nuremberg, Paracelsus Medical University, 90419 Nuremberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tilo","family":"K\u00f6lbel","sequence":"additional","affiliation":[{"name":"German Aortic Centre, Department of Vascular Medicine, University Medical Center Eppendorf, 20251 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.jvs.2019.09.055","article-title":"Outcomes of Target Vessel Endoleaks after Fenestrated-Branched Endovascular Aortic Repair","volume":"72","author":"Tenorio","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.jvs.2023.09.036","article-title":"Fate of Primary Determinate and Indeterminate Target Vessel Endoleaks after Fenestrated-Branched Endovascular Aortic Repair","volume":"79","author":"Squizzato","year":"2024","journal-title":"J. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Spanos, K., Jakimowicz, T., Nana, P., Behrendt, C.-A., Panuccio, G., Kouvelos, G., Jama, K., Eleshra, A., Rohlffs, F., and K\u00f6lbel, T. (2022). Outcomes of Directional Branches of the T-Branch Off-the-Shelf Multi-Branched Stent-Graft. J. Clin. Med., 11.","DOI":"10.3390\/jcm11216513"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1177\/15266028221083458","article-title":"Meta-Analysis of Comparative Studies Between Self- and Balloon-Expandable Bridging Stent Grafts in Branched Endovascular Aneurysm Repair","volume":"30","author":"Nana","year":"2023","journal-title":"J. Endovasc. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/j.jvs.2022.10.041","article-title":"Analysis of Predisposing Factors for Type III Endoleaks from Directional Branches after Branched Endovascular Repair for Thoracoabdominal Aortic Aneurysms","volume":"77","author":"Gennai","year":"2023","journal-title":"J. Vasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.avsg.2019.10.053","article-title":"Outcome After Fenestrated and Branched Repair of Aortic Aneurysms\u2014Device Failures Predict Reintervention Rates","volume":"66","author":"Kettunen","year":"2020","journal-title":"Ann. Vasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1177\/15266028211025019","article-title":"The Early Outcomes of BeGraft Peripheral Plus in Branched Endovascular Repair of Thoracoabdominal Aneurysms","volume":"28","author":"Abisi","year":"2021","journal-title":"J. Endovasc. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.jvs.2020.12.093","article-title":"Respiratory-Induced Changes in Renovisceral Branch Vessel Morphology after Fenestrated Thoracoabdominal Aneurysm Repair with the BeGraft Balloon-Expandable Covered Stent","volume":"74","author":"Tran","year":"2021","journal-title":"J. Vasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.ejvs.2018.01.023","article-title":"One Year Outcomes of 101 BeGraft Stent Grafts Used as Bridging Stents in Fenestrated Endovascular Repairs","volume":"55","author":"Spear","year":"2018","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1177\/1526602819866435","article-title":"Performance of BeGraft and BeGraft+ Stent-Grafts as Bridging Devices for Fenestrated Endovascular Aneurysm Repair: An In Vitro Study","volume":"26","author":"Torsello","year":"2019","journal-title":"J. Endovasc. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"15266028241231882","DOI":"10.1177\/15266028241231882","article-title":"Outcome of the Be Graft Bridging Stent in Fenestrated Endovascular Aortic Repair in a High-Volume Single Center and an Overview of Current Evidence","volume":"23","author":"Becker","year":"2024","journal-title":"J. Endovasc. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Schardt, C., Adams, M.B., Owens, T., Keitz, S., and Fontelo, P. (2007). Utilization of the PICO Framework to Improve Searching PubMed for Clinical Questions. BMC Med. Inform. Decis. Mak., 7.","DOI":"10.1186\/1472-6947-7-16"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A Tool for Assessing Risk of Bias in Non-Randomised Studies of Interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4S","DOI":"10.1016\/j.jvs.2020.06.011","article-title":"Reporting Standards for Endovascular Aortic Repair of Aneurysms Involving the Renal-Mesenteric Arteries","volume":"73","author":"Oderich","year":"2021","journal-title":"J. Vasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1002\/jrsm.1348","article-title":"Seriously Misleading Results Using Inverse of Freeman-Tukey Double Arcsine Transformation in Meta-analysis of Single Proportions","volume":"10","author":"Schwarzer","year":"2019","journal-title":"Res. Synth. Methods"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1177\/0962280216669183","article-title":"Optimally Estimating the Sample Mean from the Sample Size, Median, Mid-Range, and\/or Mid-Quartile Range","volume":"27","author":"Luo","year":"2018","journal-title":"Stat. Methods Med. Res."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Wan, X., Wang, W., Liu, J., and Tong, T. (2014). Estimating the Sample Mean and Standard Deviation from the Sample Size, Median, Range and\/or Interquartile Range. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-135"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1177\/15266028221091894","article-title":"Midterm Outcomes of BeGraft Stent Grafts Used as Bridging Stents in Fenestrated Endovascular Aortic Aneurysm Repair","volume":"30","author":"Clough","year":"2023","journal-title":"J. Endovasc. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1177\/15266028231175621","article-title":"Two-Year Outcomes With Bentley BeGraft as Bridging Stent-Grafts for Reno-Visceral Target Vessels During Fenestrated Endovascular Aortic Repair","volume":"32","author":"Mezzetto","year":"2025","journal-title":"J. Endovasc. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.ejvs.2024.10.046","article-title":"Midterm Outcomes of the BeGraft and BeGraft Plus Bridging Covered Stents for Fenestrated and Branched Endovascular Aneurysm Repair","volume":"69","author":"Katsargyris","year":"2025","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1016\/j.jvs.2016.09.045","article-title":"Early Experience with a Modified Preloaded System for Fenestrated Endovascular Aortic Repair","volume":"65","author":"Maurel","year":"2017","journal-title":"J. Vasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1177\/15266028231173309","article-title":"Predicting Features of Visceral Stent Failure in Fenestrated Endovascular Aortic Aneurysm Repair","volume":"32","author":"Mancuso","year":"2025","journal-title":"J. Endovasc. Ther."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jvs.2024.08.063","article-title":"Midterm Outcomes of the Viabahn VBX Balloon-Expandable Covered Stent for Fenestrations during Complex Endovascular Aortic Aneurysm Repair","volume":"81","author":"Pavarino","year":"2025","journal-title":"J. Vasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1177\/15266028211010455","article-title":"Performance of the Gore VBX Balloon Expandable Endoprosthesis as Bridging Stent-Graft in Branched Endovascular Aortic Repair for Thoracoabdominal Aneurysms","volume":"28","author":"Torsello","year":"2021","journal-title":"J. Endovasc. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.ejvs.2025.01.004","article-title":"Systematic Review and Meta-Analysis of Outcomes of the Advanta V12 or ICAST Bridging Stent Graft Used for Fenestrated and Branched Endovascular Aortic Repair","volume":"69","author":"Nana","year":"2025","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/j.ejvs.2025.01.029","article-title":"Editor\u2019s Choice\u2014Initial Experience with the BeFlared Bridging Covered Stent for Fenestrated Endovascular Aneurysm Repair","volume":"69","author":"Katsargyris","year":"2025","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e223","DOI":"10.1161\/CIR.0000000000001106","article-title":"2022 ACC\/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"146","author":"Isselbacher","year":"2022","journal-title":"Circulation"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.ejvs.2023.11.002","article-title":"Editor\u2019s Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms","volume":"67","author":"Wanhainen","year":"2024","journal-title":"European J. Vasc. Endovasc. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1016\/j.jvs.2019.07.079","article-title":"Outcomes of Directional Branches Using Self-Expandable or Balloon-Expandable Stent Grafts during Endovascular Repair of Thoracoabdominal Aortic Aneurysms","volume":"71","author":"Tenorio","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.avsg.2020.10.052","article-title":"Bridging Stents in Fenestrated and Branched Endovascular Aneurysm Repair: A Systematic REVIEW","volume":"73","author":"Mezzetto","year":"2021","journal-title":"Ann. Vasc. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.ejvs.2024.09.030","article-title":"Editor\u2019s Choice\u2014Role of Antiplatelet Therapy in Patients Managed for Complex Aortic Aneurysms Using Fenestrated or Branched Endovascular Repair","volume":"69","author":"Nana","year":"2025","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.jvs.2023.05.003","article-title":"Fate of Target Visceral Vessels in Fenestrated and Branched Complex Endovascular Aortic Repair","volume":"78","author":"Fargion","year":"2023","journal-title":"J. Vasc. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ejvs.2015.03.023","article-title":"Performance of Bridging Stent Grafts in Fenestrated and Branched Aortic Endografting","volume":"50","author":"Panuccio","year":"2015","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1067\/mva.2002.123763","article-title":"Reporting Standards for Endovascular Aortic Aneurysm Repair","volume":"35","author":"Chaikof","year":"2002","journal-title":"J. Vasc. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.jvs.2010.07.008","article-title":"Reporting Standards for Thoracic Endovascular Aortic Repair (TEVAR)","volume":"52","author":"Fillinger","year":"2010","journal-title":"J. Vasc. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.avsg.2019.04.049","article-title":"First\/Preliminary Experience of Gore Viabahn Balloon-Expandable Endoprosthesis as Bridging Stent in Fenestrated and Branched Endovascular Aortic Repair","volume":"61","author":"Gallitto","year":"2019","journal-title":"Ann. Vasc. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1177\/15266028211016423","article-title":"Outcomes of Advanta V12 Covered Stents After Fenestrated Endovascular Aneurysm Repair","volume":"28","author":"Schuurmann","year":"2021","journal-title":"J. Endovasc. Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e893","DOI":"10.1097\/SLA.0000000000005859","article-title":"Mid-Term Renal and Mesenteric Artery Outcomes During Fenestrated and Branched Endovascular Aortic Repair for Complex Abdominal and Thoracoabdominal Aortic Aneurysms in the United States Aortic Research Consortium","volume":"278","author":"Tenorio","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_41","first-page":"476","article-title":"Bridging Stent Grafts in Fenestrated and Branched Endovascular Aortic Repair: Current Practice and Possible Complications","volume":"60","author":"Mani","year":"2019","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.ejvs.2015.09.013","article-title":"Tortuosity Is the Significant Predictive Factor for Renal Branch Occlusion after Branched Endovascular Aortic Aneurysm Repair","volume":"51","author":"Sugimoto","year":"2016","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.ejvs.2018.07.032","article-title":"Mid-Term Results of Fenestrated\/Branched Stent Grafting to Treat Post-Dissection Thoraco-Abdominal Aneurysms","volume":"57","author":"Oikonomou","year":"2019","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.ejvs.2024.04.041","article-title":"Post-Dissection Thoraco-Abdominal Aortic Aneurysm Managed by Fenestrated or Branched Endovascular Aortic Repair","volume":"68","author":"Gorgatti","year":"2024","journal-title":"Eur. J. Vasc. Endovasc. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5221\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:14:51Z","timestamp":1760033691000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5221"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,23]]},"references-count":44,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14155221"],"URL":"https:\/\/doi.org\/10.3390\/jcm14155221","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,23]]}}}