Endovascular Repair With Fenestrated TREO Stent-Graft System in AAA

Bolton Medical20 enrolled

Overview

The goal of this clinical trial is to learn if the Fenestrated TREO Stent-Graft System works to treat abdominal aneurysms in adults. An abdominal aneurysm is a bulge in the main blood vessel (the aorta) which carries blood from the heart, through the chest and abdomen. It will also learn about the safety of Fenestrated TREO Stent-Graft System. The main question it aims to answer is: Can the the Fenestrated TREO Stent-Graft System be used to treat participants with a specific type of abdominal aneurysm called a juxtarenal abdominal aortic aneurysm? Participants will: Have the the Fenestrated TREO Stent-Graft System implanted via an endovascular surgical procedure and visit the hospital for a follow up period of 5 years, for checkups, tests and imaging scans.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Abdominal Aortic Aneurysms (AAA)

Interventions

The Fenestrated TREO Stent-Graft System is a modular, endoluminal, over-the-wire system intended for the endovascular treatment of juxtarenal and pararenal to paravisceral aneurysms requiring a fenestrated stent-graft and having suitable morphology. The system is composed of the following components: Fenestrated TREO Bifurcate Stent-Graft - The main body fenestrated bifurcate provides the following; proximal seal, fenestrations and gates for connection to the leg extensions. Bridging Stents - The bridging stent connects the main body bifurcated device to the target visceral artery allowing the target anatomy to maintain perfusion while keeping the pathology sealed TREO Leg and Straight Extension Stent-Grafts: The Leg Extension and Straight Extension stent-grafts are used to complete coverage of the pathology from the main body bifurcated device to the distal landing zones (usually the common iliac artery just proximal to the iliac bifurcation).

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18 years or older at the time of consent * Life expectancy is greater than 2 years * An abdominal aortic or aorto-iliac aneurysm requiring a fenestrated graft and with morphology suitable for endovascular repair (confirmed by Computed Tomography (CT) with contrast performed within 6 months of planned implant procedure) as follows: 1. Maximum aneurysm diameter of ≥5.5 cm for male ( ≥5.0 cm for female) or 2. Maximum AAA diameter exceeding two times the normal diameter just proximal to the aneurysm using orthogonal (i.e., perpendicular to the centerline) measurements (or saccular aneurysm that warrants treatment in the opinion of the investigator) or 3. Aneurysm with a history of growth \> 0.5 cm in 6 months and 4. Minimum 0 mm of healthy aorta\* below the most inferior renal artery that the physician plans on preserving and no renal artery involvement (juxtarenal aneurysms) or 5. At least one renal artery involved in the aneurysm and minimum 2 mm below the celiac (suprarenal aneurysms) \*Healthy aorta is defined as segment of aorta with parallel aortic wall with minimal (\<10%) or no difference in diameter and minimal atherosclerotic debris, thrombus, or calcification. * Proximal landing zone: 1. ≥20 mm length 2. 20-32 mm diameter 3. ≤60° angle relative to the axis of the suprarenal aorta 4. ≤60° angle relative to the long axis of the aneurysm * Distal (iliac) landing zone with: 1. 8-13 mm inside diameter/ ≥10 mm length 2. \>13-20 mm inside diameter/ ≥15 mm length * Distal aortic diameter (above the iliac bifurcation) ≥70% of the sum of the iliac limb graft diameters * Minimum 20 mm aortic lumen diameter at the level of the fenestrations * Pathology that requires maximum 5 fenestrations in the main body * Pathology that requires fenestration a minimum 3 mm apart (edge to edge) * Branch vessels (to be bridged to the fenestrated graft) with: 1. 5-9 mm diameters 2. ≥13 mm distal landing zone (or ≥15 mm if there is a gap between fenestration and target vessel) * Adequate renal function to tolerate contrast-enhanced CTA * Adequate vascular access compatible with required delivery systems * Willingness to comply with the follow-up evaluation schedule documented in a signed informed consent prior to implant Exclusion Criteria: * Pregnant or lactating * Dissection in abdominal aorta, ruptured aneurysm, or symptomatic aneurysm (as determined by treating physician) * Implant procedure as planned does not allow for at least one patent hypogastric artery left intact, unless both are occluded on pre-op imaging. * A branch vessel(s) that is dissected or has significant calcification, tortuosity, thrombus formation that would interfere with bridging stent delivery or sealing (as determined by treating physician) * Severe untreated coronary artery disease and/or unstable angina, significant areas of myocardium at risk (based on coronary angiogram or radionuclide scans), left ventricular ejection fraction \<20%, or recent diagnosis of congestive heart failure (CHF; as determined by treating physician). * Stroke or myocardial infarction within 6 months of the planned treatment date * Chronic obstructive pulmonary disease requiring routine need for oxygen therapy outside the hospital setting (e.g., daily or nightly home use) * Chronic Kidney Disease (CKD) stage ≥3b.\* \* During Stage 2, patients with severe CKD (stage ≥3b) can be included in the Expanded Access Arm if otherwise eligible. * Active systemic infection or is suspected of having an active systemic infection (e.g., acquired immune deficiency syndrome (AIDS)/human immunodeficiency virus (HIV), sepsis) * Clinical conditions that would severely compromise or impair x-ray visualization of the aorta (as determined by treating physician). * History of an aortopathic connective tissue disease (e.g., Marfan's syndrome) * Mycotic aneurysm * Significant or circumferential calcification or mural thrombus (as determined by treating physician): 1. in the proximal aortic neck 2. in the distal iliac landing zone 3. within the treatment length, which may adversely impact device patency * Cannot receive intraprocedural anticoagulation per the investigator's standard of care, or antiplatelet therapy post-procedurally as per the investigator's standard of care. * Blood coagulation disorder or bleeding diathesis, the treatment for which cannot be suspended pre- and post-repair * An investigational study drug or biologic within 30 days of planned procedure or an investigational device within one year of planned procedure or any other treatment that may interfere with the interpretation of the study results. * Medical, social or psychological issues that the investigator believes may interfere with study treatment or follow-up. * Untreatable allergy or sensitivity to contrast media, nitinol/nickel, Tantalum, Platinum Iridium (PtIr), 316 stainless steel, ePTFE (expanded polytetrafluoroethylene), PTFE (polytetrafluoroethylene) Impregnated polyester fiber, or polyester * Other major surgical or medical intervention within 45 days of the planned procedure or plan to undergo other major surgical or medical intervention within 45 days post implantation (e.g., coronary artery bypass graft (CABG), organ transplantation, renal stenting)

Locations (5)

Tampa General Hospital

Tampa, Florida, United States

NOT_YET_RECRUITING

Brigham and Women's Hospital

Boston, Massachusetts, United States

NOT_YET_RECRUITING

Washington University School of Medicine

St Louis, Missouri, United States

RECRUITING

Baylor Scott and White Research Institute

Plano, Texas, United States

ACTIVE_NOT_RECRUITING

University of Washington Medical Center

Seattle, Washington, United States

RECRUITING

Outcomes

Primary Outcomes

Proportion of patients with absence of a major adverse event (Primary Safety Endpoint)

The primary safety endpoint is the absence of a major adverse event (MAE) at 30-day post procedure. MAEs are defined as follows: * All-cause mortality, defined as death due to any cause * Myocardial infarction (new onset) based on the Society for Cardiovascular Angiography \& Interventions (SCAI) definition * Respiratory failure requiring prolonged (\>24 hours from anticipated) mechanical ventilation or reintubation * Renal function decline resulting in \>50% reduction from baseline estimated glomerular filtration rate (eGFR) or new-onset dialysis * Bowel ischemia requiring surgical resection or not resolving with medical therapy * Disabling stroke (modified Rankin Scale (mRS) score ≥2 at 90 days post event and an increase in ≥1 mRS category from an individual's pre-stroke baseline, as direct result of the neurological event) * Paraplegia (grade 3, Society for Vascular Surgery (SVS) Thoracic Endovascular Aortic Repair (TEVAR) guidelines)

Time frame: 30-day post-procedure

Proportion of patients with successful aneurysm treatment through 12-months post-implant procedure (Primary Effectiveness Endpoint)

The primary effectiveness endpoint is the proportion of patients with successful aneurysm treatment through 12-months post-implant procedure, which is a composite of technical success and absence of the following: * Aneurysm-related mortality: Death occurs within the first 30-days of the index procedure or a secondary intervention, OR any death that results from aneurysm rupture or an aorta-related complication (e.g., implant infection, occlusion, dissection) * Aneurysm rupture: Rupture of the native aneurysm sac (treated lesion) * Type I/III Endoleak * Aneurysm Expansion (\>5 mm) * Migration (\>10 mm) * Loss of patency (i.e., complete occlusion of the aortic implant and/or bridging stent(s)) * Conversion to open surgical repair: Explant of the investigational device due to any cause * Secondary intervention (clinically significant) to address loss of patency, fixation or seal

Time frame: 12 months post-procedure

Successful delivery and deployment of the aortic stent-graft and all modular stent-graft components (Technical Success)

Composite: * Successful access to the arterial system using remote arterial exposure, percutaneous technique, or open surgical conduit without the need for unanticipated corrective intervention related to access * Successful delivery and deployment of the aortic stent-graft and all modular stent-graft components without the need for unanticipated corrective intervention related to delivery and deployment * Successful side branch catheterization and placement of bridging stents with restoration and maintenance of flow in all intended target vessels without the need for unanticipated corrective intervention related to placement of the bridging stent(s) * Successful withdrawal of the delivery systems without the need for unanticipated corrective intervention related to withdrawal * Absence of Type I or III endoleaks (assessed by Computed Tomography Angiography, Magnetic Resonance Angiography, or duplex ultrasound) * Patency of all aortic modular stent graft components

Time frame: Evaluated 30-days post procedure

Secondary Outcomes

All-Cause Mortality

Individual component of the primary safety endpoint - defined as death due to any cause

Time frame: Evaluated at all follow up visits which occur at the following timepoints: at discharge, 30 days post-procedure, six months post-procedure, 12-months post-procedure and annually thereafter through to five years post-procedure.

Myocardial Infarction (new onset)

Individual component of the primary safety endpoint - based on the SCAI definition

Respiratory failure

Individual component of the primary safety endpoint - respiratory failure requiring prolonged (\>24 hours from anticipated) mechanical ventilation or reintubation

Renal function decline

Individual component of the primary safety endpoint - Renal function decline resulting in \>50% reduction from baseline eGFR or new-onset dialysis

Bowel ischemia

Individual component of the primary safety endpoint - Bowel ischemia requiring surgical resection or not resolving with medical therapy

Disabling stroke

Paraplegia

Individual component of the primary safety endpoint -Paraplegia grade 3, as per SVS TEVAR guidelines

Aneurysm-related mortality

Individual components of the primary effectiveness endpoint - defined as death which occurs within the first 30-days of the index procedure or a secondary intervention, OR any death that results from aneurysm rupture or an aorta-related complication (e.g., implant infection, occlusion, dissection)

Aneurysm rupture

Individual components of the primary effectiveness endpoint - Rupture of the native aneurysm sac (treated lesion)

Type I/III Endoleak

Individual components of the primary effectiveness endpoint - Presence of Type I/IIIEndoleak as confirmed by imaging

Aneurysm Expansion

Individual components of the primary effectiveness endpoint - Aneurysm expansion (\>5 mm)

Device Migration

Individual components of the primary effectiveness endpoint - Device migration (\>10mm)

Loss of device patency

Individual components of the primary effectiveness endpoint - complete occlusion of the aortic implant and/or bridging stent(s)

Conversion to open surgical repair

Individual components of the primary effectiveness endpoint - Explant of the investigational device due to any cause

Secondary intervention (clinically significant) to address loss of patency, fixation or seal

Individual components of the primary effectiveness endpoint. This includes the following reasons for re-intervention: Loss of Patency: Complete occlusion of the aortic endovascular graft, bridging stent(s), and/or limb(s) Seal: Type Ia/Ib, IIIa/IIIb/IIIc Endoleaks Fixation: Fracture, Kink, Migration Device System Prophylaxis: Device-related Reintervention requiring hospitalization Minor Secondary Interventions will not count against the endpoint and include the following: Endovascular procedures (completed for any reason), specifically percutaneous transluminal angioplasty, atherectomy, stenting without thrombectomy or thrombolysis Interventions to address branch vessel stenosis Interventions to address Type II endoleaks Minor surgical revisions (e.g., patch angioplasty) of the access vessel

Technical Success (at the index procedure)

Technical Success (at the index procedure) is a composite of the following: * Successful access to the arterial system using remote arterial exposure, percutaneous technique, or open surgical conduit without the need for unanticipated corrective intervention related to access. * Successful delivery and deployment of the aortic stent-graft and all modular stent-graft components without the need for unanticipated corrective intervention related to delivery and deployment. * Successful side branch catheterization and placement of bridging stents with restoration and maintenance of flow in all intended target vessels without the need for unanticipated corrective intervention related to placement of the bridging stent(s) * Successful withdrawal of the delivery systems without the need for unanticipated corrective intervention related to withdrawal.

Time frame: At time of index procedure

Presence of endoleak

Evaluation of the presence of all endoleak types, as confirmed by imaging

Aneurysm size changes

Evaluation of changes in aneurysm size. Enlargement is defined as \>5mm, regression is ≥ 5 mm.

Device Migration Evaluation

Evaluation of device migration. Migration is defined as \>10mm.

Patency related observations

Stenosis and occlusion of the components of the Fenestrated TREO Stent-Graft System

Loss of device integrity

Fracture of stent strut, barb, or fenestration ring in Fenestrated TREO, fracture of stent in any Fenestrated TREO system implant

Target vessel instability

Target vessel instability is a composite endpoint consisting of the following side branch complications: * Death related to side branch complication(s) * Rupture related to side branch complication(s) * Secondary intervention to address a side branch-related complication

Secondary interventions related to the device/treated lesion

Any secondary interventions that are performed that are related to the device or the treated lesion will be recorded.

Target vessel complications

Including dissection and/or perforation

Access-related complications

Serious Adverse Events

As per protocol definition

Operative metrics - Time

Information relating to the time of the surgical procedure such as start time, stop time, duration of procedure (min) and length of endovascular time (min)

Time frame: Perioperative

Operative metrics - Number of Vessels intended to be Perfused via Fenestrated TREO Fenestrations

Information relating to the number and name of the vessels to be perfused via the Fenestrated TREO Fenestrations

Time frame: Evaluated at time of implant