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

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 “very low” for primary outcomes. Target vessel technical success was 99% (95% CI 98–100%; I2 = 12%). The mean follow-up was 20.2 months. Target-vessel instability was 3% (95% CI 2–5%; I2 = 44%), occlusion/stenosis was 1% (95% CI 1–4%; I2 = 8%) and endoleak Ic/IIIc was 1% (95% CI 0–3%; I2 = 0%). The estimated target-vessel reintervention was 2% (95% CI 2–4%; I2 = 12%). Celiac trunk, superior mesenteric and renal artery instability were 1% (95% CI 0–16%; I2 = 0%;), 1% (95% CI 0–5%; I2 = 14%) and 4% (95% CI 2–7%; 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.