Clinical Effectiveness of an Off-the-shelf Single REnal Scalloped sTent-graft for HOstile NEck Infrarenal Abdominal Aortic Aneurysm: Clinical Pivotal Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 50
- 试验地点
- 1
- 主要终点
- Evaluation of the clinical effectiveness of the endovascular exclusion of infrarenal Abdominal Aortic Aneurysm with a single renal scallop endograft
研究概览
简要总结
The goal of this multicenter, observational cohort study is to evaluates the clinical effectiveness of a single-renal scallop custom-made stent-graft (TREO, Terumo Aortic, Sunrise, FL) to treat "hostile" AAA with mismatched renal arteries as actual standard of care in this Vascular Unit The main question it aims to answer are: if a dedicated devices could improve the results in the endovascular treatment of patients suffering to infrarenal abdominal aortic aneurism with a mismatched takeoff of the renal arteries.
Participants responding to inclusion criteria will be treated as best clinical practice with a custom made device with a single scallop for the renal artery. The minimum follow-up requested, as standard clinical practice, was: 3-months, 12-18 months- and 5-years CTA; clinical and DUS examination at 6- and 12- and 36-months after the intervention and yearly thereafter.
No comparison group was present.
详细描述
Endovascular aneurysm repair (EVAR) is currently the preferred choice to treat the abdominal aortic aneurysms (AAA) with a feasible anatomy. However, approximately 40-60% of AAA patients presented unfavorable characteristics for EVAR, mainly due to a "hostile neck anatomy". In ''real-world'' clinical practice, up to 44% of EVAR cases are performed outside Instruction For Use (IFU) for an adverse neck anatomy6. Short (<15-mm), angulated (>60°), and wide (>28-mm) aortic necks are the main features concurring to the proximal HNA.
The recourse to standard EVAR is currently routine for patients who are not eligible for OR, with acceptable short- and mid-term outcomes, but the long-term durability of EVAR depends on maintaining proper sealing between the endograft and the aortic neck as well as the iliac arteries. HNAs demonstrated worse results when compared to "favorable" ones in terms of technical success (94% vs. 98%) and type-Ia endoleak rate (10% vs. 2%). The issue linked to an unfavorable anatomy can be addressed with more complex techniques, but these are limited by high production costs and considerable complexity .
TREO (Terumo Aortic, Inchinnan, Renfrewshire, UK; formerly Treovance, Bolton Medical, Sunrise, Fla) is a standard bifurcated, modular stent-graft that has shown compelling early- and mid-term results. It seems clear that several physicians are still looking for a feasible solution for HNA patients to keep the complexity of the procedure comparable to standard EVAR while yielding improved results.
Moreover, there is a lack of publications addressing the issue of mismatched take-off of the renal arteries (RAs). This morphology seems to influence the sealing length and could justify the introduction of dedicated devices. A recent study from our group currently under review for publication demonstrated that 25% of patients eligible for EVAR presented with mismatched RAs and that a dedicated device could improve sealing significantly. The study group sealing zone's length increased by about 25% when applying a hypothetical prototype with a single 10x10mm (wide x high) renal scallop. The same approach could be applied to the sealing surface with similar results. In the light of obtained results in selected patients, the use of a "single renal-scallop" custom-made device has been our standard of care.
The results will demonstrate whether the supra mentioned graft can the treatment of AAA with mismatched RAs in the real world. The effectiveness will be evaluated in terms of technical and clinical success.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients affected by infrarenal AAA > 50mm
- •Treated in election for non-symptomatic AAA
- •Anatomy inside Treo (Terumo Aortic) instruction to use (IFU)
- •Distance between renal arteries >10mm on aortic center-lumen-line
- •Age > 18
- •Patient fit to plead
- •Written informed consent
- •Treated in the coordinator center or in one of the study's participating centers
- •Minimum follow-up requested: 3-months, 12-18 months and 5-years CTA; clinical and DUS examination at 6- and 12- and 36-months after the intervention and yearly thereafter
排除标准
- •Patients with aortic pathologies different from AAA (aortic ulcers, dissection, pseudo-aneurysm etc)
- •Treated in urgent/emergent setting for symptomatic or ruptured AAA
- •AAA < 50mm
- •Outside TREO (Terumo Aortic) IFU
- •With an inter-renal distance measured of the center-lumen-line <10mm
- •Unfit to plead
- •Refused to sign the informed consent
- •Treated outside the coordinator centers or in one of the study's participating center's
- •Refusal to adhere to the requested follow-up
结局指标
主要结局
Evaluation of the clinical effectiveness of the endovascular exclusion of infrarenal Abdominal Aortic Aneurysm with a single renal scallop endograft
时间窗: up to 24 hours
Clinical effectiveness measured in terms of technical and clinical success. Technical success was defined as successful introduction and deployment of the device in the absence of surgical conversion or mortality, type I or III endoleaks, or graft limb obstruction. A technical success thus implies the following qualifying details: 1. Successful access to the arterial system using a remote site; 2. successful deployment of the endoluminal graft with secure proximal and distal fixation; 3. absence of either a type I or III endoleak; 4. patent endoluminal graft without significant twist, kinks, or obstruction by intraoperative measurements; 5 patency of both renal arteries and at least one hypogastric artery.
次要结局
- Evaluation of the average fluoroscopy time(up to 24 hours)
- Evaluation time elapsed from procedure to re-intervention("through study completion, an average of 2 years".)
- Evaluation of the association between baseline and anatomical features to adverse technical success, clinical success and reintervention rate("through study completion, an average of 2 years".)
- Evaluation of the average contrast medium (CM)(up to 24 hours)
- Evaluation of the average dose absorption (DAP) mGy/m3(up to 24 hours)
- Evaluation of reintervention rate("through study completion, an average of 2 years".)
- Evaluation of the average procedural time(up to 24 hours)
- Evaluation of the intra-operative and peri-operative (within 30 days) adverse events(up to 30 days)
- Collection of eventual adverse events related to the treatment procedure and eventual post-hoc analysis("through study completion, an average of 2 years".)
研究者
Roberto Silingardi, MD
Medical Doctor
Azienda Ospedaliero-Universitaria di Modena