{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T05:06:33Z","timestamp":1779512793087,"version":"3.53.1"},"reference-count":13,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"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: Complex EVAR is a well-established option for treating complex aortic pathologies. However, depending on the type of it, long-term effectiveness is often compromised. For example, chimney EVAR is related to type IA endoleaks related to the gutter and proximal neck degeneration, late failures after fenestrated or branched EVAR are rare. Although redo-endovascular procedures are recommended for failed repairs, the use of branched endoprostheses (BEVAR) to address failed Complex EVAR (C-EVAR) cases is rarely documented. This study aims to evaluate the technical feasibility and 30-day outcomes of using BEVAR as a definitive rescue strategy for these patients. Methods: A retrospective single-center analysis was conducted on a series of twelve patients who had previously undergone failed C-EVAR. Clinical and procedure-related variables were collected. Statistical analysis was performed using Stata v18.0 software. Results: The reasons for reintervention were type Ia endoleak (ten patients), type Ib (one patient), and type III + Ia (one patient). Branched devices were used: eleven patients received the Zenith t-Branch (Cook Medical, Bloomington, IN, USA), and one received the G-Branch device (Lifetech Scientific, Shenzhen, China). Technical and clinical success was achieved in 11 out of 12 patients (91.7%). One perioperative death (due to haemothorax and sepsis) and three major complications were recorded in the first 30 days following repair. No patient of this cohort was deemed fit enough for open conversion. Imaging follow-up at 30 days revealed two type I leaks and seven type II leaks, with no type III leaks recorded. Patency was maintained in all treated visceral vessels (the celiac trunk, the superior mesenteric artery, and the renal arteries) in survivors. Conclusions: Repairing failed C-EVAR using branched endovascular aneurysm repair is a feasible and effective technique. This approach can resolve complex issues such as proximal sealing and component integrity failures, successfully excluding the aneurysmal sac while avoiding the morbidity and mortality associated with open surgery in high-risk patients.<\/jats:p>","DOI":"10.3390\/jcm15103888","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T14:40:31Z","timestamp":1779115231000},"page":"3888","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Branched Endovascular Aneurysm Repair (BEVAR) to Rescue Failed Complex EVAR (C-EVAR): Technical Challenges and Outcomes in a 12-Case Series"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9725-6484","authenticated-orcid":false,"given":"Marco Virgilio","family":"Usai","sequence":"first","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, St. Franziskus-Hospital, 48145 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7198-9384","authenticated-orcid":false,"given":"Blanca","family":"Exp\u00f3sito-Camacho","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, Fundaci\u00f3n Alcorc\u00f3n University Hospital, 28922 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Franke","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, St. Franziskus-Hospital, 48145 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imam T. P.","family":"Ritonga","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, St. Franziskus-Hospital, 48145 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6397-8765","authenticated-orcid":false,"given":"Jorge","family":"Balaguer-Germ\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Puerta de Hierro University Hospital, 28035 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin J.","family":"Austermann","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery, St. Franziskus-Hospital, 48145 M\u00fcnster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jvscit.2020.10.015","article-title":"The use of an inner branch endograft for the treatment of failed chimney endovascular aortic repair","volume":"7","author":"Dayan","year":"2020","journal-title":"J. Vasc. Surg. Cases Innov. Tech."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.avsg.2025.05.019","article-title":"Perioperative and Midterm Outcomes of Branched or Fenestrated Endovascular Aneurysm Repair for Type 1A Endoleak after Endovascular Aneurysm Repair","volume":"121","author":"Pierie","year":"2025","journal-title":"Ann. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.avsg.2025.03.022","article-title":"Endovascular Treatment of Thoracoabdominal Aortic Pathologies in the Fourth Segment with Branched Custom-Made Devices with a Short Proximal Sealing Zone","volume":"118","author":"Usai","year":"2025","journal-title":"Ann. Vasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.ejvs.2023.07.029","article-title":"Editor\u2019s Choice\u2014The VASCUNExplanT Project: An International Study Assessing Open Surgical Conversion of Failed Non-Infected Endovascular Aortic Aneurysm Repair","volume":"66","author":"Behrendt","year":"2023","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1024\/0301-1526\/a001252","article-title":"The preliminary European multi-centre experience with G-Branch Endograft","volume":"55","author":"Youssef","year":"2026","journal-title":"Vasa"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1016\/j.jvs.2019.10.068","article-title":"Secondary interventions after fenestrated and branched endovascular repair of complex aortic aneurysms","volume":"72","author":"Silverberg","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.jvs.2019.11.026","article-title":"Results of fenestrated and branched endovascular aortic aneurysm repair after failed infrarenal endovascular aortic aneurysm repair","volume":"72","author":"Schanzer","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1016\/j.jvs.2022.11.037","article-title":"Systematic review of reintervention with fenestrated or branched devices after failed previous endovascular aortic aneurysm repair","volume":"77","author":"Nana","year":"2023","journal-title":"J. Vasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.ejvs.2021.06.038","article-title":"Editor\u2019s Choice\u2014Multicentre Outcomes of Redo Fenestrated\/Branched Endovascular Aneurysm Repair to Rescue Failed Fenestrated Endografts","volume":"62","author":"Karelis","year":"2021","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.avsg.2020.02.018","article-title":"The Midterm Results of Fenestrated and Branched Aneurysm Repair of Previous Failed Fenestrated EVAR","volume":"67","author":"Hongku","year":"2020","journal-title":"Ann. Vasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1177\/15266028231174113","article-title":"Fenestrated Endovascular Aortic Repair After Failed Endovascular Aortic Repair","volume":"32","author":"Taher","year":"2025","journal-title":"J. Endovasc. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.jvs.2017.12.036","article-title":"Reinterventions after fenestrated or branched endovascular aortic aneurysm repair","volume":"68","author":"Dossabhoy","year":"2018","journal-title":"J. Vasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1530","DOI":"10.1016\/j.jvs.2021.11.074","article-title":"Secondary interventions after fenestrated\/branched aneurysm repairs are common and nondetrimental to long-term survival","volume":"75","author":"Zettervall","year":"2022","journal-title":"J. Vasc. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3888\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T04:22:52Z","timestamp":1779510172000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3888"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":13,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103888"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103888","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]}}}