Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
J Surg Res. 2019 Sep;241:48-52. doi: 10.1016/j.jss.2019.03.048. Epub 2019 Apr 17.
Aneurysmal sac shrinkage is associated with successful aneurysm repair after endovascular aortic repair (EVAR). There are a variety of approved aortic endografts, with a recent study demonstrating increased sac shrinkage in certain endografts compared with others. The TREO endograft (Terumo Aortic Ltd, Renfrewshire, Scotland, UK) is being evaluated for use in EVAR, with preliminary data demonstrating high rates of success. The objective of this study is to evaluate sac shrinkage of the TREO endograft.
This is a retrospective analysis of EVARs at a single institution by a high-volume surgeon over a 1-year period in which the TREO graft was used. The change in sac size and rate of sac shrinkage (mm/mo) were evaluated between TREO and non-TREO grafts. All TREO grafts were included in the analysis. Non-TREO grafts were matched a priori for TREO indications for use anatomic specifications. Non-TREO grafts were also excluded for traumatic or emergent cases. The primary outcome was sac shrinkage, and secondary outcomes were composite complication profile within 30 d of operation.
Six TREO grafts and 16 non-TREO grafts were included for analysis. The groups were similar in age, gender, and race. The groups were also similar in aortic anatomy before EVAR. The aneurysm sac shrinkage rate (mm/mo) is significantly greater in the TREO group than in the non-TREO group (0.484 ± 0.107 versus 0.018 ± 0.112, P = 0.033). The total average size of sac shrinkage was also greater for the TREO group (-0.688 ± 2.262 versus 12.00 ± 2.78, P < 0.001). The composite complication profile of stroke, myocardial infarction, death, and respiratory complications was not different between groups.
TREO aortic endografts for aneurysm repair are being used in Europe. However, their application in the United States is limited. Our data demonstrate the significant advantage the TREO graft has with increased sac shrinkage and minimal complications, compared with other grafts. This study adds to the growing body of literature supporting TREO graft use for EVAR.
在血管内主动脉修复（EVAR）后，动脉瘤囊缩小与动脉瘤修复成功相关。有多种已批准的主动脉内支架，最近的一项研究表明，某些内支架比其他支架的囊缩小更多。TREO 支架（Terumo Aortic Ltd，Renfrewshire，苏格兰，英国）正在 EVAR 中进行评估，初步数据显示成功率很高。本研究旨在评估 TREO 支架的囊缩小情况。
这是一家高容量外科医生在一年时间内在一家机构进行的 EVAR 的回顾性分析，在此期间使用了 TREO 移植物。在 TREO 移植物和非 TREO 移植物之间评估了囊大小的变化和囊缩小率（mm/月）。所有 TREO 移植物均纳入分析。根据 TREO 使用适应症和解剖学规格，预先匹配非 TREO 移植物。还排除了外伤性或紧急情况下的非 TREO 移植物。主要结果是囊缩小，次要结果是术后 30 天内的复合并发症情况。
纳入 6 个 TREO 移植物和 16 个非 TREO 移植物进行分析。两组在年龄、性别和种族方面相似。两组在 EVAR 前的主动脉解剖结构方面也相似。TREO 组的动脉瘤囊缩小率（mm/月）明显高于非 TREO 组（0.484±0.107 与 0.018±0.112，P=0.033）。TREO 组的囊总平均缩小量也更大（-0.688±2.262 与 12.00±2.78，P<0.001）。两组的卒中、心肌梗死、死亡和呼吸并发症的复合并发症情况无差异。
TREO 主动脉内支架用于动脉瘤修复正在欧洲使用。然而，它们在美国的应用受到限制。我们的数据表明，与其他支架相比，TREO 支架在囊缩小和最小并发症方面具有显著优势。这项研究增加了越来越多的支持 TREO 支架用于 EVAR 的文献。
