Endovascular Repair of Juxtarenal Aortic Aneurysm

NCT ID: NCT04252079

Last Updated: 2020-02-05

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-03-01

Study Completion Date

2021-09-01

Brief Summary

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The investigators compare different endovascular techniques as an alternative to surgical reconstruction to repair JAAS regarding ; success rates, 30-day mortality,endoleak events secondary intervention rates

Detailed Description

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Aortic disease is the direct cause of close to 10000 deaths annually in the United States. 1

Aneurysmal disease can affect any segment of the aorta, from the aortic root to the aortic bifurcation. Juxtarenal Aortic Aneurysms (JAA) (where a specialty designed custom -made device (endograft)which has holes, or fenestrations ,on the graft body to maintain the patency of the visceral arteries) account for approximately 15% of abdominal aortic aneurysms.2

Successful aortic aneurysm treatment depends on either open replacement or endovascular exclusion of the aneurysmal segment with healthy artery proximal and distal to the repair.

The decision to treat an AAA is based on the associated risk of treatment, the risk of aneurysm rupture, the patient's life expectancy, and patient preference.

The primary determinant of rupture risk is maximum aneurysm diameter, with negligible rupture risk in aneurysms \<4cm in diameter compared with aneurysms \>8 cm . 3, 4.

The Society for Vascular Surgery recommends repair for all patients of acceptable perioperative risk with an AAA ≥5.5 cm in diameter as well as all patients with saccular and symptomatic aneurysms.5 ,6

These guidelines also suggest repair for women at a diameter of 5.0 cm.

Fenestrated Endovascular Aneurysm Repair (FEVAR) and Chimney Endovascular Aneurysm Repair (CHEVAR)are both effective methods to treat JAAs

Conditions

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Juxtarenal Aortic Aneurysm

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Prospective cross sectional study
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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We compare different endovascular techniques as an alternative

We compare different endovascular techniques as an alternative to surgical reconstruction to repair JAAS regarding ; success rates, 30-day mortality, endoleak events secondary intervention rates

Group Type OTHER

Endovascular Repair of Juxtarenal Aortic Aneurysm

Intervention Type PROCEDURE

1. History taking and clinical examination.
2. Preoperative Imaging

CTA is the cross-sectional imaging modality of choice.
3. Preoperative evaluation

a-Renal evaluation

b\_ cardiac evaluation C-Pulmonary evaluation
4. Surgical techniques

1. Anesthesia The use of general anesthesia due to the duration of the procedures and the necessity to control patient breathing to allow precise imaging and accurate device deployment.
2. Intra operative imaging A "hybrid" operating room with high-quality fixed imaging is needed for the performance of FEVAR.

C-Device delivery and deployment all FEVAR procedures begin with access of the femoral arteries by either open or percutaneous technique.

Interventions

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Endovascular Repair of Juxtarenal Aortic Aneurysm

1. History taking and clinical examination.
2. Preoperative Imaging

CTA is the cross-sectional imaging modality of choice.
3. Preoperative evaluation

a-Renal evaluation

b\_ cardiac evaluation C-Pulmonary evaluation
4. Surgical techniques

1. Anesthesia The use of general anesthesia due to the duration of the procedures and the necessity to control patient breathing to allow precise imaging and accurate device deployment.
2. Intra operative imaging A "hybrid" operating room with high-quality fixed imaging is needed for the performance of FEVAR.

C-Device delivery and deployment all FEVAR procedures begin with access of the femoral arteries by either open or percutaneous technique.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* • Subject is ≥18 years old

* Subject is scheduled for treatment of the juxtarenal aortic aneurysm with a short infrarenal neck aortic neck length \<15 mm, neck angulation \>60%, conical neck) (i.e. denovo cases).
* Subject is able and willing to comply with the protocol and to adhere to the follow-up requirements.
* Subject has provided written informed consent.

Exclusion Criteria

* Subject is participating in a concurrent study which may confound study results

* Subject has a life expectancy ≤1 year
* Subject has an aneurysm that is:

* Mycotic
* Inflammatory
* Pseudoaneurysm
* Subject requires emergent aneurysm treatment, for example, trauma or rupture
* Subject has previously undergone surgical treatment for abdominal aortic aneurysm
* Subject is a female of childbearing potential in whom pregnancy cannot be excluded
* Subject has a known hypersensitivity or contraindication to anticoagulants, anti-platelets, or contrast media, which is not amenable to pre-treatment.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Assiut University

OTHER

Sponsor Role lead

Responsible Party

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Khaled Mohamed Awad Hassan

Assistant lecturer

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ashraf G Taha, MD

Role: STUDY_DIRECTOR

Assistant professur Assiut University

Central Contacts

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Khaled M Awad, Master

Role: CONTACT

01006797162

Ashraf M Abo Bakr, MD

Role: CONTACT

01005212168

References

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Taylor SM, Mills JL, Fujitani RM. The juxtarenal abdominal aortic aneurysm. A more common problem than previously realized? Arch Surg. 1994 Jul;129(7):734-7. doi: 10.1001/archsurg.1994.01420310066011.

Reference Type BACKGROUND
PMID: 8024454 (View on PubMed)

Brown LC, Powell JT. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Ann Surg. 1999 Sep;230(3):289-96; discussion 296-7. doi: 10.1097/00000658-199909000-00002.

Reference Type BACKGROUND
PMID: 10493476 (View on PubMed)

Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, Mastracci TM, Mell M, Murad MH, Nguyen LL, Oderich GS, Patel MS, Schermerhorn ML, Starnes BW. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018 Jan;67(1):2-77.e2. doi: 10.1016/j.jvs.2017.10.044.

Reference Type BACKGROUND
PMID: 29268916 (View on PubMed)

Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, van Herwaarden JA, Holt PJ, van Keulen JW, Rantner B, Schlosser FJ, Setacci F, Ricco JB; European Society for Vascular Surgery. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011 Jan;41 Suppl 1:S1-S58. doi: 10.1016/j.ejvs.2010.09.011. No abstract available.

Reference Type BACKGROUND
PMID: 21215940 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 21092788 (View on PubMed)

Coselli JS, LeMaire SA, Preventza O, de la Cruz KI, Cooley DA, Price MD, Stolz AP, Green SY, Arredondo CN, Rosengart TK. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg. 2016 May;151(5):1323-37. doi: 10.1016/j.jtcvs.2015.12.050. Epub 2016 Jan 14.

Reference Type BACKGROUND
PMID: 26898979 (View on PubMed)

Eagleton MJ, Follansbee M, Wolski K, Mastracci T, Kuramochi Y. Fenestrated and branched endovascular aneurysm repair outcomes for type II and III thoracoabdominal aortic aneurysms. J Vasc Surg. 2016 Apr;63(4):930-42. doi: 10.1016/j.jvs.2015.10.095. Epub 2016 Jan 11.

Reference Type BACKGROUND
PMID: 26792544 (View on PubMed)

Other Identifiers

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Aortic aneurysm repair

Identifier Type: -

Identifier Source: org_study_id

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