Physician-Modified Fenestrated and Branched Aortic Endografting for TAAA

NCT ID: NCT02989948

Last Updated: 2025-09-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

38 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-04-22

Study Completion Date

2031-12-31

Brief Summary

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The primary clinical objective of this study is to evaluate the safety and effectiveness of a physician-modified, fenestrated and branched aortic endoprosthesis for the treatment of thoracoabdominal aortic aneurysms (TAAAs). The goal of the primary analysis is to demonstrate both the safety and effectiveness of using a physician-modified fenestrated Cook Zenith Alpha Thoracic Endovascular Graft as compared to previously published results of open surgical replacement of the aneurysmal aorta.

Detailed Description

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This study is a prospective, two-arm, traditional feasibility study of a physician modified fenestrated Cook Zenith Alpha Thoracic Endovascular Graft base device in adult patients meeting traditional size criteria for open surgical treatment of thoracoabdominal aortic aneurysms (TAAAs). Patients meriting surgical treatment of their aneurysm that also meet inclusion and exclusion criteria will be eligible for enrollment. Patients will be followed for 5 years post procedure. Major adverse events (MAEs) will also be recorded by the Sponsor-Investigator (S-I) and will be monitored by a locally appointed Data Monitoring Committee, Dartmouth-Hitchcock Health and the D-HH Human Research Protection Program IRB/IEC, and the FDA. This record was transferred to Yale in October 2024.

Conditions

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Aortic Aneurysm, Thoracoabdominal

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Main Arm - Physician-modified fenestrated endovascular graft

Use of a physician-modified fenestrated Cook Zenith Alpha Thoracic Endovascular Graft for the endovascular treatment of asymptomatic, non-ruptured thoracoabdominal aortic aneurysms of any Crawford extent (I-V) meeting traditional size criteria for open surgical repair.

Group Type EXPERIMENTAL

Physician-modified aortic endograft

Intervention Type DEVICE

Use of physician-modified fenestrated Cook Zenith Alpha Thoracic Endovascular Graft for the endovascular treatment of asymptomatic, non-ruptured thoracoabdominal aortic aneurysms of any Crawford extent (I-V) meeting traditional size criteria for open surgical repair.

Expanded Access Arm - Physician-modified fenestrated endovascular graft.

Use of a physician-modified fenestrated Cook Zenith Alpha Thoracic Endovascular Graft for the endovascular treatment of asymptomatic, non-ruptured thoracoabdominal, thoracic, or abdominal aortic aneurysms of any Crawford extent (I-V) meeting traditional size criteria for open surgical repair in an expanded use population.

Group Type EXPERIMENTAL

Physician-modified aortic endograft

Intervention Type DEVICE

Use of physician-modified fenestrated Cook Zenith Alpha Thoracic Endovascular Graft for the endovascular treatment of asymptomatic, non-ruptured thoracoabdominal aortic aneurysms of any Crawford extent (I-V) meeting traditional size criteria for open surgical repair.

Interventions

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Physician-modified aortic endograft

Use of physician-modified fenestrated Cook Zenith Alpha Thoracic Endovascular Graft for the endovascular treatment of asymptomatic, non-ruptured thoracoabdominal aortic aneurysms of any Crawford extent (I-V) meeting traditional size criteria for open surgical repair.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Must be a man or woman 50 years of age or older by the date of informed consent.
2. Must have a thoracoabdominal aortic aneurysm of any Crawford classification (extent I-V) that extends no more proximal than the left subclavian artery.
3. Must have an aneurysm size that meets standard indications for surgical repair (6.0 cm in maximum diameter in the descending thoracic aorta, or 5.5 cm in maximum diameter in the abdominal aorta).
4. Must be considered, in the judgment of the S-I, to be a high risk candidate for open surgical repair.
5. Must not be a candidate for repair under the Instructions for Use of a commercially available, FDA-approved endovascular graft.
6. Must be able to provide informed consent.
7. Must be able to comply with the five year study assessment schedule of events.
8. Must have a non-aneurysm-related life expectancy, in the judgment of the S-I, of greater than 2 years.


1. Must be a man or woman 50 years of age or older by the date of informed consent
2. Must have a thoracic, thoracoabdominal, or abdominal aortic aneurysm that necessitates coverage of one or more visceral vessels (celiac, superior mesenteric, or renals) for establishment of proximal and/or distal seal.
3. Must have an aneurysm size that meets standard size indications for surgical repair (6.0 cm in maximum diameter in the descending thoracic aorta, or 5.5 cm in maximum diameter in the abdominal aorta); or, in the judgment of the S-I, has aneurysm characteristics that portend a high risk of near-term rupture
4. Must be considered, in the judgement of the S-I, to be a high risk candidate for open surgical repair
5. Must not be a candidate for repair under the Instructions for Use of a commercially available, FDA-approved endovascular graft
6. Patient must be able to provide informed consent
7. Must be able to comply with the five year study assessment schedule of events
8. Must have a non-aneurysm-related life expectancy, in the judgement of the S-I, of greater than 2 years

Exclusion Criteria

1. Aneurysm due to acute or chronic dissection, intramural hematoma, penetrating aortic ulceration, pseudoaneurysm, mycotic aneurysm, or traumatic transection.
2. Ruptured or acutely symptomatic aortic aneurysm.
3. Known connective tissue disorder.
4. Imaging demonstrating any of the following:

* Lack of 20 mm non-aneurysmal proximal seal zone (zone 3, or zone 2 with a carotid-subclavian bypass or transposition).
* Lack of 15 mm non-aneurysmal distal seal zone(s) (aortic, common iliac, or external iliac).
* Branch vessel target (renal, superior mesenteric, or celiac) \< 5 mm or \> 10 mm in average diameter.
* Untreated left subclavian artery stenosis or occlusion.
* Untreated unilateral or bilateral hypogastric artery occlusion.
* Signs that the inferior mesenteric artery is indispensable.
* Have branching, duplication, aneurysm, or untreatable stenosis of the celiac, superior mesenteric artery, or renal arteries that would preclude implantation of the investigational devices.
5. Known sensitivities or allergies to stainless steel, PTFE, polyester, polypropylene, nitinol, or gold.
6. History of anaphylaxis to contrast, with inability to prophylax appropriately.
7. Have uncorrectable coagulopathy.
8. Have unstable angina.
9. Have a body habitus that would inhibit X-ray visualization of the aorta.
10. Have a major surgical or interventional procedure unrelated to the treatment of the aneurysm planned ≤30 days of the endovascular repair.
11. Known to be participating in any other clinical study which may affect performance of this device.
12. Known, visible, or suspected pregnancy, confirmed with a Urine Pregnancy Test (UPT)
13. Contraindication to oral antiplatelet therapy.
14. Prisoners or those on alternative sentencing.
15. Known systemic infection with potential for endovascular graft infection.
16. Anticipated need for MRI scanning within 3 months of insertion of investigational product.
17. Other conditions or comorbidities that, in the opinion of the S-I, would exclude the patient.


1. Known or suspected mycotic aneurysm
2. Ruptured aneurysm with hemodynamic instability
3. Known connective tissue disorder
4. Imaging demonstrating any of the following:

* Lack of 20 mm non-aneurysmal proximal seal zone (in either native aorta, elephant trunk graft, or aortic arch endograft)
* Lack of 15 mm non-aneurysmal distal seal zone(s) (in either native aortoiliac vessels, prosthetic aortoiliac grafts, or aortoiliac endografts)
* Branch vessel target (renal, superior mesenteric, or celiac) \> 10 mm in average diameter
5. Known sensitivities or allergies to stainless steel, PTFE, polyester, polypropylene, nitinol, or gold
6. History of anaphylaxis to contrast, with inability to prophylax appropriately.
7. Have uncorrectable coagulopathy
8. Have a body habitus that would inhibit X-ray visualization of the aorta
9. Have a major surgical or interventional procedure unrelated to the treatment of the aneurysm planned ≤ 30 days of the endovascular repair
10. Known to be participating in any other clinical study which may affect performance of this device
11. Known, visible, or suspected pregnancy, confirmed with a Urine Pregnancy Test (UPT)
12. Contraindication to oral antiplatelet therapy
13. Prisoners or those on alternative sentencing
14. Known systemic infection with potential for endovascular graft infection
15. Anticipated need for MRI scanning within 3 months of insertion of investigational product
16. Other conditions or comorbidities that, in the opinion of the S-I, would exclude the patient
Minimum Eligible Age

50 Years

Maximum Eligible Age

95 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Yale University

OTHER

Sponsor Role lead

Responsible Party

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David Kuwayama

Associate Professor of Surgery

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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David P. Kuwayama, M.D., M.P.A.

Role: PRINCIPAL_INVESTIGATOR

Yale University

Locations

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Yale New Haven Hospital

New Haven, Connecticut, United States

Site Status

Countries

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United States

References

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Crawford ES, Coselli JS. Thoracoabdominal aneurysm surgery. Semin Thorac Cardiovasc Surg. 1991 Oct;3(4):300-22. No abstract available.

Reference Type BACKGROUND
PMID: 1793767 (View on PubMed)

Safi HJ, Miller CC 3rd. Spinal cord protection in descending thoracic and thoracoabdominal aortic repair. Ann Thorac Surg. 1999 Jun;67(6):1937-9; discussion 1953-8. doi: 10.1016/s0003-4975(99)00397-5.

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Dapunt OE, Galla JD, Sadeghi AM, Lansman SL, Mezrow CK, de Asla RA, Quintana C, Wallenstein S, Ergin AM, Griepp RB. The natural history of thoracic aortic aneurysms. J Thorac Cardiovasc Surg. 1994 May;107(5):1323-32; discussion 1332-3.

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Kuzmik GA, Sang AX, Elefteriades JA. Natural history of thoracic aortic aneurysms. J Vasc Surg. 2012 Aug;56(2):565-71. doi: 10.1016/j.jvs.2012.04.053.

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Clouse WD, Hallett JW Jr, Schaff HV, Gayari MM, Ilstrup DM, Melton LJ 3rd. Improved prognosis of thoracic aortic aneurysms: a population-based study. JAMA. 1998 Dec 9;280(22):1926-9. doi: 10.1001/jama.280.22.1926.

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Cowan JA Jr, Dimick JB, Henke PK, Rectenwald J, Stanley JC, Upchurch GR Jr. Epidemiology of aortic aneurysm repair in the United States from 1993 to 2003. Ann N Y Acad Sci. 2006 Nov;1085:1-10. doi: 10.1196/annals.1383.030.

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O'Callaghan A, Mastracci TM, Eagleton MJ. Staged endovascular repair of thoracoabdominal aortic aneurysms limits incidence and severity of spinal cord ischemia. J Vasc Surg. 2015 Feb;61(2):347-354.e1. doi: 10.1016/j.jvs.2014.09.011. Epub 2014 Oct 23.

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Lee JT, Lee GK, Chandra V, Dalman RL. Comparison of fenestrated endografts and the snorkel/chimney technique. J Vasc Surg. 2014 Oct;60(4):849-56; discussion 856-7. doi: 10.1016/j.jvs.2014.03.255. Epub 2014 Apr 27.

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Greenberg R, Eagleton M, Mastracci T. Branched endografts for thoracoabdominal aneurysms. J Thorac Cardiovasc Surg. 2010 Dec;140(6 Suppl):S171-8. doi: 10.1016/j.jtcvs.2010.07.061.

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Greenberg RK, Lu Q, Roselli EE, Svensson LG, Moon MC, Hernandez AV, Dowdall J, Cury M, Francis C, Pfaff K, Clair DG, Ouriel K, Lytle BW. Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair: a comparison of endovascular and open techniques. Circulation. 2008 Aug 19;118(8):808-17. doi: 10.1161/CIRCULATIONAHA.108.769695. Epub 2008 Aug 4.

Reference Type BACKGROUND
PMID: 18678769 (View on PubMed)

Matsumura JS, Melissano G, Cambria RP, Dake MD, Mehta S, Svensson LG, Moore RD; Zenith TX2 Clinical Trial Investigators. Five-year results of thoracic endovascular aortic repair with the Zenith TX2. J Vasc Surg. 2014 Jul;60(1):1-10. doi: 10.1016/j.jvs.2014.01.043. Epub 2014 Mar 14.

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Riga CV, McWilliams RG, Cheshire NJ. In situ fenestrations for the aortic arch and visceral segment: advances and challenges. Perspect Vasc Surg Endovasc Ther. 2011 Sep;23(3):161-5. doi: 10.1177/1531003510388421. Epub 2011 Apr 17.

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Browne TF, Hartley D, Purchas S, Rosenberg M, Van Schie G, Lawrence-Brown M. A fenestrated covered suprarenal aortic stent. Eur J Vasc Endovasc Surg. 1999 Nov;18(5):445-9. doi: 10.1053/ejvs.1999.0924.

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Starnes BW. Physician-modified endovascular grafts for the treatment of elective, symptomatic, or ruptured juxtarenal aortic aneurysms. J Vasc Surg. 2012 Sep;56(3):601-7. doi: 10.1016/j.jvs.2012.02.011. Epub 2012 May 2.

Reference Type BACKGROUND
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Other Identifiers

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2000035699

Identifier Type: OTHER

Identifier Source: secondary_id

D18194

Identifier Type: -

Identifier Source: org_study_id

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