Indications, safety, and effectiveness of transcatheter electrosurgical septotomy during endovascular repair of aortic dissections.
Lucas Ruiter Kanamori, Emanuel R Tenorio, Dora Babocs...
https://pubmed.ncbi.nlm.nih.gov/39074740/Actively Recruiting
Led by Baylor College of Medicine · Updated on 2026-01-20
760
Participants Needed
3
Research Sites
269 weeks
Total Duration
Researchers are evaluating the safety and effectiveness of the Zenith t-Branch and customized physician-specified stent-grafts with fenestrations and branches to repair complex abdominal, thoracoabdominal, and aortic arch aneurysms or dissections. These aneurysms cause bulges or weaknesses in major blood vessels, which can lead to serious complications if ruptured. This traditional device feasibility study aims to collect preliminary safety and efficacy information to guide future research and product development. The study involves two groups of patients. The first group includes those with complex abdominal or thoracoabdominal aortic aneurysms treated with either an off-the-shelf Zenith t-Branch or patient-specific stent-grafts featuring 1 to 5 small holes fenestrations or side branches, along with stents in arteries to the liver, intestine, and kidneys. The second group includes patients with aortic arch aneurysms treated with patient-specific stent-grafts containing one to three inner branches or scallops to align with arteries supplying the brain and arms. All grafts are inserted through arteries in the groin or leg using catheters, a procedure known as endovascular repair. Participants will be monitored through various assessments including survival and adverse events at 30 days post-treatment. The study also measures treatment success at 12 months and tracks quality of life over several years. Follow-up includes imaging, physical exams, and questionnaires at multiple time points up to five years. The study will gather detailed clinical data to understand how well these fenestrated and branched stent-grafts work and to ensure patient safety during and after the procedure.
CONDITIONS
CAAAs, TAAAs, Aortic Arch Aneurysms or Dissections With Fenestrated/Branched Stent Graft
A
Andrea C Martinez, MS
Y
Ying Huang, MD, PhD
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Baylor College of Medicine
Lead Sponsor
William Cook Australia
Collaborating Sponsor
This table compares participation in this trial with other options available for this condition. The information is drawn from published research and the trial’s study details and is provided for educational purposes only.
| Factors | Zenith Fenestrated/Branched Endovascular System (CAAA/TAAA) | Zenith Arch Branch Endovascular System (Aortic Arch) | Open Surgical Repair (Current-Care Context) |
|---|---|---|---|
| What it is | A minimally invasive endovascular approach using patient-specific or off-the-shelf Zenith fenestrated and branched stent grafts to treat complex abdominal (CAAA) or thoracoabdominal (TAAA) aortic aneurysms. The device is deployed through arteries in the leg to reinforce the aorta and align branch arteries. | A minimally invasive endovascular repair using the Zenith Arch Branch stent-graft, which includes a main aortic arch graft and up to three branch cuffs matching the patient’s anatomy. The device is positioned in the aortic arch with branch stents connecting to major arteries. | Traditional open surgical repair involves direct replacement of the aorta with a synthetic graft through a large abdominal or chest incision, with re-implantation of key branch arteries as necessary. |
| Role in trial | Experimental arm for patients with eligible complex abdominal or thoracoabdominal aneurysms. | Experimental arm for patients with eligible aortic arch aneurysms or dissections. | Current standard-of-care treatment for similar patients, but not included as a randomized trial arm. |
| Primary use | Treatment of complex abdominal or thoracoabdominal aortic aneurysms in patients considered at high risk for open surgery or with challenging anatomy. | Repair of aortic arch aneurysms or dissections using a custom endovascular approach for high-risk or anatomically complex patients. | Definitive repair of complex aortic aneurysms or dissections for eligible patients, particularly those considered suitable for major open surgery. |
| How it is given or performed | The stent-graft system is placed inside the aorta using catheters inserted through the leg arteries. Small branch stents align with the arteries to the liver, kidneys, and intestines. The procedure is minimally invasive and may require adjunct open/revascularization techniques. | A main aortic arch stent-graft and branch stents for the head vessels are positioned using a combination of transfemoral (leg) and possibly upper extremity access, with additional graft customization as needed. | A large abdominal or chest incision is used to access the aorta. The aneurysmal section is removed and replaced with a synthetic graft, and major side branches are reattached to restore blood flow. |
| Evidence status | Midterm data from prospective studies support technical success and survival in selected patients undergoing fenestrated-branched endovascular repair, but long-term effectiveness compared to open repair is still being determined. | Early and feasibility data indicate technical success and safety are achievable in carefully selected aortic arch aneurysm cases, but large-scale or long-term outcome data are limited. | Long-term evidence supports open surgical repair as the definitive treatment with durable aneurysm exclusion, but the operation carries substantial perioperative risk, especially in medically high-risk patients. |
| Important risks | Risks include perioperative mortality, major adverse events (e.g., stroke, spinal cord injury, renal injury, endoleak), device complications, and need for secondary interventions. | Risks include stroke, device migration or malfunction, vessel injury, spinal cord or neurological complications, and possible need for surgical conversion or reintervention. These may be higher compared to standard endovascular cases due to aortic arch anatomy. | Open surgical repair carries significant risks including perioperative death, major bleeding, respiratory or cardiac complications, paraplegia, kidney injury, and prolonged recovery. |
| Important limitations | Requires suitable anatomy for graft alignment; long-term durability and the need for reinterventions remain uncertain. Not all patients are eligible—some anatomic configurations may preclude device use. | Feasibility and technical complexity limit use to specialized centers; device customization is often required, and long-term outcomes are not yet fully known. | Open surgery involves major incisions, longer hospital stays, and increased recovery time compared with endovascular repair; perioperative risks can be prohibitive for frail or medically complex patients. |
| Patient impact | Endovascular repair may shorten recovery time, hospital stay, and decrease initial perioperative morbidity compared to open repair for eligible patients, although reintervention and surveillance remain necessary. | Minimally invasive approach offers a potential alternative to open surgery with less surgical trauma in selected patients, but requires ongoing imaging follow-up and may need additional secondary interventions. | Open surgical repair offers proven long-term durability for aneurysm exclusion but is associated with a longer hospital stay, major recovery period, and higher early complication rates. |
Disclaimer: This comparison is created with the help of artificial intelligence(AI) and may contain errors or missing information. It is not medical advice and does not mean one option is better or safer than another. Clinical trials are still being studied, and joining a trial is your choice. Please consult your healthcare professional before making any decisions.
You may qualify if you...
You will not qualify if you...
Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
1 visit (in-person)
Duration - Single procedure
Participants will have a fenestrated or branched endovascular graft implanted through arteries in the leg or aortic arch to repair aneurysms. This procedure uses catheters to place the graft and associated stents to keep arteries open and aligned with the graft's fenestrations or branches.
1 procedure visit (in-person)
Duration - Up to 5 years post treatment
Participants are monitored with follow-up visits to assess safety, treatment success, and quality of life at various time points after graft implantation.
Visits at 30 days, 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years post treatment
Study Type
INTERVENTIONAL
Masking
NONE
Allocation
NON_RANDOMIZED
Model
SINGLE_GROUP
Primary Purpose
TREATMENT
Number of Arms
2
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https://pubmed.ncbi.nlm.nih.gov/30714570/Baylor College of Medicine
Lead Sponsor
William Cook Australia
Collaborating Sponsor