A novel 14F endograft for abdominal aortic aneurysm: first in man.
OBJECTIVE
This study evaluated the feasibility of percutaneous endovascular treatment of infra-renal abdominal aortic aneurysm (AAA) using the novel low profile modular Tripelay system (Tripelay, France).


BACKGROUND
Endovascular aortic aneurysm treatment (EVAR) has become more widely used as early mortality has been significantly reduced. Also, percutaneous access has become possible with the introduction of vascular closure devices and with the initial reduction in size of delivery catheters. However, percutaneous access is not commonly used and anatomical considerations, such as access vessel size and tortuousities, preclude a number of patients from being efficiently treated with EVAR.


METHODS
The novel Tripelay system enables two semicircular preshaped self-expandable stentgrafts to be positioned side by side on the aneurysm neck extending into the iliac arteries. Each stentgraft being smaller than the target vessel diameter, the delivery catheter is reduced in size (14F) and accommodates with smaller and more tortuous access vessels than conventional devices. This device was used to treat a 57-year-old male patient with significant comorbidities (previous coronary artery bypass grafting (CABG) and abdominal surgeries, smoking, hypertension, obesity, hyperlipidemia). Percutaneous access was made on both femoral arteries. The device was inserted, positioned, and deployed as planned. Iliac extensions were used bilaterally.


RESULTS
The EVAR procedure was performed successfully, and the patient was discharged on day 6. Follow-up computed tomography scans at 1, 6, and 12 months revealed perfect exclusion of the aneurysm sac, patent stentgraft, and vessels, and no prosthesis migration, endoleaks or stent fracture were observed. The patient remained asymptomatic and reported no adverse events during that period.


CONCLUSIONS
The Tripelay system seemed as an effective and user friendly tool for treatment of AAAs. Of course, this procedure still needs further clinical evaluation with more cases and longer follow-up to confirm long-term efficacy and safety of this device.
Laborde
Jean Claude
JC
Glenfield Hospital, Leicester, United Kingdom.
Kipshidze
Nickolas
N
Ruiz
Carlos E
CE
D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000295:instrumentation*; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome