{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:43:09Z","timestamp":1771375389782,"version":"3.50.1"},"reference-count":12,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"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>This is a single-center study about upward facing in branched endovascular aortic repair. Background: The evolution of branched endovascular aortic repair (BEVAR) has introduced upward-facing branches as a novel approach to facilitate exclusive transfemoral access in complex aortic aneurysm repair. This study evaluates the feasibility, safety, and early outcomes of custom-made BEVAR devices incorporating upward-facing branches in patients with cranially oriented renal arteries. The investigation further aims to analyze the technical success and mid-term outcomes related to these novel devices, as well as to identify any challenges or complications specific to the use of upward-facing branches in clinical practice. Methods: We retrospectively analyzed 17 patients treated at a single center between January 2020 and December 2024 using custom-made Cook Medical branched stent grafts with at least one upward-facing branch. Demographics, comorbidities, target vessel details, bridging stent graft (BSG) configurations, and procedure-related complications were collected. The primary endpoints were technical success and branch patency. Secondary endpoints included short- and mid-term branch-related complications. Results: The cohort had a mean age of 70 years, with hypertension (88%) and coronary artery disease (47%) being common comorbidities. Technical success was achieved in 100% of cases. The left renal artery was the most frequently targeted vessel (63.2%). Most upward-facing branches were bridged using a combination of balloon-expandable and self-expandable stents. One patient (5.9%) experienced a renal bleeding complication requiring embolization. There were no cases of primary stent occlusion or dislocation. At a mean follow-up of 14 months, one asymptomatic occlusion of an upward-facing branch was detected in computed tomography angiography. No further upward-facing branch-related complications occurred, and 1-year follow-up was available in 41.2% of patients. Conclusions: In our single-center study including 17 patients, upward-facing branches in BEVAR demonstrate high technical success and a low complication rate, offering a promising alternative to traditional access strategies. These findings support broader adoption in select anatomical scenarios, pending larger comparative studies and longer-term data collection.<\/jats:p>","DOI":"10.3390\/jcm14176106","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T08:01:01Z","timestamp":1756454461000},"page":"6106","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rethinking Access in BEVAR: Single-Center Experience of the Feasibility of Upward-Facing Branches"],"prefix":"10.3390","volume":"14","author":[{"given":"Philipp","family":"Franke","sequence":"first","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, St. Franziskus-Hospital M\u00fcnster, 48145 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2851-279X","authenticated-orcid":false,"given":"Imam Tongku Padesma","family":"Ritonga","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, St. Franziskus-Hospital M\u00fcnster, 48145 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3930-8362","authenticated-orcid":false,"given":"Bachar","family":"Al Haj","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, St. Franziskus-Hospital M\u00fcnster, 48145 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yousef","family":"Shehada","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, St. Franziskus-Hospital M\u00fcnster, 48145 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Austermann","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, St. Franziskus-Hospital M\u00fcnster, 48145 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9725-6484","authenticated-orcid":false,"given":"Marco Virgilio","family":"Usai","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, St. Franziskus-Hospital M\u00fcnster, 48145 M\u00fcnster, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"744","DOI":"10.21037\/acs-2021-taes-24","article-title":"Endovascular repair for thoracoabdominal aortic aneurysms: Current status and future challenges","volume":"10","author":"Tenorio","year":"2021","journal-title":"Ann. 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Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.jvs.2020.12.078","article-title":"Effect of branch length and tortuosity on the outcomes of branched endovascular repair of thoracoabdominal aneurysms using self-expandable bridging stent graft","volume":"74","author":"Piazza","year":"2021","journal-title":"J. Vasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kolet, R., Usai, M.V., Shehada, Y., Berekhoven, B., Weyer-Elberich, V., and Austermann, M. (2025). Three Year Data on the Performance of Three Bridging Stent Grafts in Renal Arteries in Branched Endovascular Repair of Thoraco-abdominal Pathologies. Eur. J. Vasc. Endovasc. Surg., in press.","DOI":"10.1016\/j.ejvs.2025.02.034"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/j.jvs.2022.10.009","article-title":"Aortic Research Consortium. 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Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1016\/j.jvs.2020.11.020","article-title":"Comparison of transfemoral versus upper extremity access to antegrade branches in branched endovascular aortic repair","volume":"73","author":"Eilenberg","year":"2021","journal-title":"J. Vasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.ejvs.2016.03.018","article-title":"Mid-term Outcomes of Renal Branches Versus Renal Fenestrations for Thoraco-abdominal Aneurysm Repair","volume":"52","author":"Mastracci","year":"2016","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"15","DOI":"10.14797\/mdcvj.1200","article-title":"Branched and Fenestrated Aortic Endovascular Grafts","volume":"19","author":"Atkins","year":"2023","journal-title":"Methodist. Debakey Cardiovasc. 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Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6106\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:34:58Z","timestamp":1760034898000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6106"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,29]]},"references-count":12,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14176106"],"URL":"https:\/\/doi.org\/10.3390\/jcm14176106","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,29]]}}}