Doctor-modified endovascular grafts to repair juxtarenal aortic aneurysms

Physician Modified Endovascular Grafts for the Treatment of Elective, Symptomatic or Ruptured Juxtarenal Aortic Aneurysms

This tests doctor-modified stent grafts to repair juxtarenal abdominal aortic aneurysms in adults who are high risk for open surgery, including elective, symptomatic, or ruptured cases.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 15 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: The Cleveland Clinic (Academic / other)
• Locations: 1 site (Cleveland, Ohio)
• Trial ID: NCT06657794 on ClinicalTrials.gov

What this trial studies

This interventional study uses physician-modified Terumo Aortic TREO abdominal stent grafts implanted endovascularly to treat juxtarenal aortic aneurysms in patients deemed high risk for open repair. The trial focuses on technical and treatment success immediately after the procedure, tracks major adverse events at 30 days, and follows subjects for effectiveness and durability out to five years. Enrollment is limited to adults with appropriate vascular anatomy who lack other suitable treatment options. Procedures and follow-up are conducted at the Cleveland Clinic.

Who should consider this trial

Good fit: Adults (≥18) with juxtarenal abdominal aortic aneurysms—elective, symptomatic, or ruptured—who are considered high risk or unsuitable for open repair and have anatomy compatible with a physician-modified TREO graft are ideal candidates.

Not a fit: Patients who are good candidates for standard open repair, who lack the vascular anatomy needed for the modified graft, are pregnant, or have active systemic infection are unlikely to benefit from this option.

Why it matters

Potential benefit: If successful, this approach could offer a less invasive treatment option for high-risk patients who cannot undergo open surgery and may reduce early complications while providing durable aneurysm exclusion.

How similar studies have performed: Similar physician-modified and fenestrated endograft approaches have been used previously with encouraging but limited data, so this builds on techniques that have shown promise but are not yet definitively proven.

Eligibility criteria

Inclusion Criteria:

All patients must meet all of the following inclusion criteria to be eligible for enrollment into the study:

1. Patient is ≥ 18 years of age
2. Patients who are male or non-pregnant female (females of child bearing potential must have a negative pregnancy test prior to enrollment into the study)
3. Patient or Legally Authorized Representative has signed an Institutional Review Board (IRB) approved Informed Consent Form
4. Patient has a juxtarenal abdominal aortic aneurysm that meets at least one of the following:

   1. An aneurysm with a maximum diameter of ≥ 5.5 cm for male (≥ 5.0 cm for female) or 2 times the normal diameter just proximal to the aneurysm using orthogonal (i.e., perpendicular to the centerline) measurements
   2. Aneurysm with a history of growth \> 0.5 cm in 6 months
   3. Saccular aneurysm deemed at significant risk for rupture
   4. Symptomatic aneurysm
   5. Ruptured aneurysm
5. Patient has patent iliac or femoral arteries, with or without the use of conduit, that will allow endovascular access with the physician modified endovascular graft.
6. Patient has a suitable non-aneurysmal proximal aortic neck of ≥ 2 mm inferior to the most distal renal artery ostium.
7. Patient has a suitable non-aneurysmal distal iliac artery length (seal zone) of ≥ 15mm. The resultant repair should preserve patency in at least one hypogastric artery.
8. Patient has a suitable non-aneurysmal proximal aortic neck diameter between 20 and 32 mm, averaged across the diameters at the Celiac, SMA, at the lowest patent renal artery and at the midpoint of the renal arteries.
9. Patient has suitable non-aneurysmal distal common iliac diameters between 8 and 20 mm.
10. Patient has juxtarenal aortic neck angulation ≤ 60°
11. Target branch vessel diameter ≥ 5 mm.
12. Patient must be willing to comply with all required follow-up exams.

Exclusion Criteria:

Patients that meet ANY of the following are not eligible for enrollment into the study:

1. Patient has a mycotic aneurysm or has an active systemic or local infection that may increase the risk of endovascular infection
2. Patient has unstable angina (defined as angina with a progressive increase in symptoms, new onset at rest or nocturnal angina, or onset of prolonged angina)
3. Patient has a major surgical or interventional procedure, not related to the endovascular repair, planned within +/- 30 days of the AAA repair.
4. Patient has history of an aortopathic connective tissue disease (e.g. Marfan's or Ehler's-Danlos syndrome).
5. Patient has a known hypersensitivity or contraindication to anticoagulation or contrast media that is not amenable to pre-treatment.
6. Patient has known allergy or intolerance to stainless steel, nitinol or gold (gold-coated tungsten).
7. Patient has a body habitus that would inhibit X-ray visualization of the aorta
8. Patient has a limited life expectancy of less than 1 year
9. Patient is currently participating in another investigational device or drug clinical trial
10. Patient has other medical, social or psychological conditions that, in the opinion of the investigator, preclude them from receiving the pretreatment, required treatment, and post-treatment procedures and evaluations.
11. Thrombus or excessive calcification within the neck of the aneurysm
12. Branch vessel stenosis ≥ 80%
13. Patient treatable on label with FDA approved EVAR or FEVAR device and can wait for device availability.
14. Subject is willing and eligible to enroll in a manufacturer-sponsored study at the investigational site, or the subject is willing and eligible to participate in a study with a manufacturer-made device at another institution.

Where this trial is running

Cleveland, Ohio

• Cleveland Clinic — Cleveland, Ohio, United States (Recruiting)

Study contacts

• Study coordinator: Yuki Kuramochi, BSN, RN

Conditions Juxtarenal Aortic Aneurysm; Aortic Rupture