Division of Vascular Surgery, University of South Florida College of Medicine, Tampa, FL.
Department of Radiology, Tampa General Hospital, Tampa, FL.
Ann Vasc Surg. 2024 Sep;106:369-376. doi: 10.1016/j.avsg.2024.04.009. Epub 2024 May 31.
Fenestrated endovascular aortic aneurysm repair (FEVAR) has been widely applied for the treatment of pararenal (PAA) and thoracoabdominal aortic aneurysms (TAAA). If custom-made devices or off-the-shelf devices are not available, physician-modified endografts (PMEGs) are an alternative device option. Several different endograft platforms have been used for PMEG; however, minimal data exists on utilizing the Terumo TREO abdominal stent graft system in this setting. The purpose of this study was to evaluate our single-center experience treating PAA and TAAA, with a physician-modified FEVAR, using the Terumo TREO platform.
A prospective database of consecutive patients with PAA and TAAA treated at a single center, with a FEVAR, utilizing a PMEG device between March 2021 and September 2023 was queried for those having a Terumo TREO device implanted. The demographics, operative details, and postoperative complications were analyzed. The rates of technical success, type I or III endoleak, branch vessel status, reintervention, and 2-year survival were also assessed.
Of the 153 patients who underwent FEVAR with a PMEG device during the study period, 100 had repair using a Terumo TREO stent graft. The mean age of the cohort was 73.7 ± 7.0 years with the majority suffering from hypertension (n = 94, 94%), coronary artery disease (n = 51, 51%), and chronic obstructive pulmonary disease (n = 40, 40%). Thirty-four patients (34%) had a prior failed EVAR device in place. The mean aneurysm size was 66.0 ± 13.7 mm, with 58 (50%) patients classified as PAA and 30 (30%) patients as an extent IV TAAA. Six (6%) patients presented with symptomatic/ruptured aneurysms. The average number of target arteries incorporated per patient was 3.8 ± 0.6. The overall technical success was 99%, procedure time was 218 ± 116 min, contrast volume was 82 ± 21 mL, and cumulative air kerma was 3,054 ± 1,560 mGy. Postoperative complications were present in 20 patients (20%), and 2 patients (2%) died within 30 days. Rates of type I or III endoleak, branch vessel stenosis or occlusion, and reintervention were 2%, 1%, and 7%, respectively. The two-year overall survival was 87%.
Treatment of PAA and the extent IV TAAA using a physician-modified fenestrated Terumo TREO endograft is safe and effective. This large, early experience using the Terumo TREO platform supports preferential use of this device in this setting due to the device design and low likelihood of type I or III endoleak.
开窗型血管内主动脉瘤修复术（fenestrated endovascular aortic aneurysm repair，FEVAR）已广泛应用于治疗肾周型（pararenal，PAA）和胸腹主动脉瘤（thoracoabdominal aortic aneurysms，TAAA）。如果无法使用定制设备或现成设备，则可以选择医师修改的内置移植物（physician-modified endografts，PMEGs）。已经使用了几种不同的内置移植物平台来进行 PMEG；然而，关于在这种情况下使用 Terumo TREO 腹主动脉支架移植物系统的数据很少。本研究的目的是评估我们单中心使用 Terumo TREO 平台进行医师修改的 FEVAR 治疗 PAA 和 TAAA 的经验。
对 2021 年 3 月至 2023 年 9 月期间在单中心接受 FEVAR 治疗的 PAA 和 TAAA 患者的连续患者前瞻性数据库进行查询，以评估使用 PMEG 装置进行 FEVAR 的患者，其中植入了 Terumo TREO 装置。分析了人口统计学、手术细节和术后并发症。还评估了技术成功率、I 型或 III 型内漏、分支血管状态、再次干预和 2 年生存率。
在研究期间，153 例患者接受了 PMEG 装置的 FEVAR，其中 100 例使用 Terumo TREO 支架移植物进行了修复。该队列的平均年龄为 73.7±7.0 岁，大多数患有高血压（n=94，94%）、冠心病（n=51，51%）和慢性阻塞性肺疾病（n=40，40%）。34 例（34%）患者之前有失败的 EVAR 设备。平均动脉瘤大小为 66.0±13.7mm，58 例（50%）患者为 PAA，30 例（30%）患者为 IV 型 TAAA。6 例（6%）患者出现症状性/破裂性动脉瘤。每位患者纳入的目标动脉平均数量为 3.8±0.6。总体技术成功率为 99%，手术时间为 218±116 分钟，造影剂用量为 82±21mL，累积空气比释动能为 3054±1560mGy。20 例患者（20%）出现术后并发症，2 例（2%）患者在 30 天内死亡。I 型或 III 型内漏、分支血管狭窄或闭塞和再次干预的发生率分别为 2%、1%和 7%。2 年总体生存率为 87%。
使用医师修改的 fenestrated Terumo TREO 内置移植物治疗 PAA 和 IV 型 TAAA 是安全有效的。这项大型早期使用 Terumo TREO 平台的经验支持在这种情况下优先使用该设备，因为该设备设计和发生 I 型或 III 型内漏的可能性较低。
