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Home > Press Center > New Technology Available for Certain Aneurysms

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Jill Goodwin
Director of Communications
312-334-2308

Novel technology for the treatment of complex aortic aneurysms with side branches that provide critical blood supply to organs they must reach was recently reviewed in the Journal of Vascular Surgery.

Roy Greenberg, MD, director of endovascular research at the Cleveland Clinic Foundation said that 50 patients with aneurysms with side branches and who were considered unfit for open surgery were first treated with branched devices in a prospective study.

“When aneurysm disease is extensive it can result in cardiopulmonary issues, renal dysfunction and paraplegia, increasing morbidity and mortality,” said Dr. Greenberg. “Surgical repair of such aneurysm has been associated a with high risk of morbidity and mortality. These issues may be minimized by less invasive approaches.”

The following aneurysms were present in the study: thoracoabdominal (TAA) in 9 patients; suprarenal
(SRA) in 20 patients; and common iliac aneurysm (CIA) in 21 patients, of which 18 had bilateral common
iliac aneurysms. 

“Some articles have appeared in the literature saying that fenestrated endovascular grafting may be used to treat aneurysms that abut the visceral vessels, however there are only case reports of early experience with branched endografts for TAA, internal iliac and brachiocephalic vessels,” said Dr. Greenberg. 

“In our study an endovascular graft using the Zenith™ platform was customized to fit TAA or SRA) patient anatomy and combined with Jomed™ balloon expandable stentgrafts. Pre-fabricated hypogastric branches were used with a Zenith™ AAA or fenestrated device in conjunction with a Viabahn™ or Fluency™ stentgraft.  “Fenestrated proximal components were required for 8 of the 21 CIA patients and Zenith Tri-fab™ was used for the rest of the repairs, and there were no coversions, ruptures or migrations,” added Dr. Greenberg.

“Success was defined by device placement, cannulation and stenting of all intended branches with survival through 24 hours. This occurred for all patients but one in the SRA group, who died from myocardial infarction in this time period.

Mean aneurysm sizes were 7.6 cm for TAA, 7.2 cm and for SRA, and the mean common iliac aneurysm size was 3.8 cm in conjunction with a mean abdominal aortic aneurysm size of 6.1 cm. Sixty-five percent of the patients’ aneurysms decreased in size by more than 5 mm within six months of treatment. At 12 months, all 10 patients evaluated had sac shrinkage greater than 5 mm. No aneurysms increased in size. According to Dr. Greenberg aneurysm regression in conjunction with patency of the visceral vessels during the follow-up period, shows that the natural history of the disease was reversed and the treatment did not jeopardize end
organ perfusion.

Endoleaks were uncommon. All type I and III endoleaks were treated before 6 months, and the three type 2 endoleaks found at discharge, underwent spontaneous resolution (1 case), treatment with glue embolization (one case), and one remains patent under observation. Five deaths occurred (2 TAA, 2 SRA,1 CIA) and three of which were related to the aneurysm repair and 9 patients (three from each of the three devices) had additional procedures, all of which were successful,” added Dr. Greenburg.

“Intermediate-term safety and efficacy of endovascular repair over open surgery in low risk patients with infrarenal aneurysms gives promise for minimally invasive technologies,” added Dr. Greenberg, “Branched devices preserving internal iliac flow do not complicate endograft planning, are relatively simple to use and the technical failure rate is low.  In contrast, application to TAA remains challenging, so it is important to initiate training programs to develop expertise with three dimensional imaging techniques, iliac branched grafts and simple fenestrated grafts prior to addressing treatment of SRA and TAA. 

“Further investigation is needed to optimize the engineering aspects of device construct, to minimize of the potential for intercomponent fatigue, and to address the physiologic needs of individual end-organs with respect to perfusion. Ultimately, we must work to come up  with devices that are simple to plan and implant,” said Dr. Greenberg. “With any new technology long-term stability of such repairs must await prolonged follow-up studies, but the short-term outcomes and surrogate markers of successful endovascular aneurysm repair are encouraging."