J. Geiger1, B. Kedwai1, S. Najjar1, M. Balceniuk1, M. Stoner1 1University of Rochester Medical Center, Department Of Surgery, Division Of Vascular Surgery, Rochester, NY, USA
Introduction:
Aneurysmal sac regression is an important predictor of successful endovascular aortic repair (EVAR). Prior work has demonstrated the TREO endograft (Terumo Aortic Ltd, Renfrewshire, Scotland, UK) results in greater sac regression over a 12-month period compared to other commercially available endografts in a small series. The objective of this follow-up study is to compare a larger cohort of TREO and non-Treo endografts over a mid-term follow up period and compare rates of sac regression.
Methods:
This is a retrospective analysis of all EVARs completed at a single, high-volume institution from January 2015 to June 2022, excluding emergent cases. Clinical data were collected from the institution’s Vascular Quality Initiative (VQI) and computed tomographic data was collected from patients’ electronic records. The analysis included all TREO and age and comorbidity-matched non-TREO endografts that satisfied anatomic indications for the use of the TREO graft. The primary outcomes were sac regression at 12, 24 and 36 months, and secondary outcomes were rates of endoleak and reintervention.
Results:
Our inclusion criteria yielded fifteen TREO grafts that were matched to thirty-three non-TREO grafts for analysis. The groups were similar in demographics, comorbidities, preoperative anatomy, and preoperative AAA sac size. The mean infrarenal AAA sac size at 2 years post EVAR was 38.1 ± 8.4 versus 50.4 ± 7.1 (p=0.007) for the TREO and non-TREO groups, respectively (Figure 1). The mean absolute change in sac size (mm) was significantly greater in the TREO cohort compared to the non-TREO cohort (-11.75 ± 9.1 versus – 4.63 ± 5.6, p = 0.007) over the study period. The rate of aneurysm sac regression (mm/month) was also increased in the TREO group compared to the non-TREO group (0.62 ± 0.36 versus 0.18 ± 0.29, p = 0.012). The rate of all-cause endoleaks after the index procedure (40.0% versus 27.3%, p = 0.585) and the rate of reintervention (6.7% (1) versus 6.1% (2), p = 0.936) were similar between TREO and non-TREO cohorts.
Conclusion:
This study demonstrates significant increases in both overall aneurysmal sac regression and rate of sac regression when utilizing the TREO endograft, as compared to non-TREO endografts, during a 36-month follow-up period. While the short term-outcomes of the TREO graft are well documented, these findings suggest that the TREO endograft offers better long-term outcomes with respect to sac reduction with no differences in the incidence of endoleak or reintervention.
