Early Results of the Bolton Treovance Endograft in the Treatment of Abdominal Aortic Aneurysms
Purpose: To present early results with the Treovance aortic stent-graft in the treatment of abdominal aortic aneurysms (AAAs). Methods: Between October 2013 and January 2016, 35 consecutive AAA patients (mean age 74±7.7 years; 32 men) were treated with Treovance. The maximum diameter of the treated AAA was 60±9 cm. Nine (25%) patients presented with concomitant iliac aneurysms. Seven (20%) AAAs had infrarenal neck angulation >60°. The infrarenal neck length and diameter were 21.6±12.6 mm and 25.7±4.6 mm, respectively. Sixteen (45%) AAAs had a reversed tapered neck contour. Six (17%) and 9 (25%) patients showed severe or moderate iliac tortuosity, respectively. Primary endpoints were endoleak, reintervention, and aneurysm-related death. Results: Primary technical success was 94% due to 2 intraoperative type Ia endoleaks, which were successfully treated with a proximal aortic extension (100% assisted primary technical success). Local dissection was encountered in 5 (7%) of 70 femoral artery access sites in 4 patients. During a mean 12-month follow-up (range 6–24), clinical success was 97%. No type I or III endoleak, death, AAA rupture, open conversion, or device-related serious adverse events were documented. Four type II endoleaks were detected; one resolved spontaneously at 12 months and 2 remained stable, while one associated with AAA sac enlargement was treated successfully with embolization of the lumbar arteries (3% reintervention rate). Conclusion: Treovance shows accurate deployment even through angulated and tortuous iliac vessels and presents satisfactory conformability in highly angulated necks with acceptable clinical results. Future development to lower the profile and increase the flexibility of its delivery system will enhance its applicability in cases of narrow access vessels.