Toshihisa Asakura
Current Position
ProfessorDepartment of Cardiovascular Surgery, Saitama Medical University International Medical Center
Japanese Society for Vascular Surgery
Abdominal Aorta & Aortic iliac Session

Topic: New taste for EVAR - TREO as a Cherry-pick device


Current several papers report EVAR has an early survival benefit but an inferior late survival compared with open repair. To overcome this issue, new generation devices are conceive and manufactured.
TREO is one of the latest generation device in Japan. Cherry-picking mean to pick only the best things from a group. I have summarized new designs of TREO such as a) widest range of sizes of main body, b) suprarenal stent and long main body, c) Z-stent configuration with wider space, d) double fixation with supra and infra renal barbs, e) both suprarenal and Infrarenal barbs completely covered during deployment, f) lock stent technology, g) low profile sheath, h) leave behind sheath.
I would like to introduce initial experience of TREO in our center. Particularly, TREO seems to be suitable in the cases of long neck, angulated neck, irregular neck, and IMA coverage. On the other hand, suprarenal angulated cases are not good candidate for TREO. Push up and reverse slider technique are not suitable for TREO. I have summarized TREO. Although TREO is a cherry-pick device, TREO is totally different from similar other devices because TREO has distinctive advanced design for AAA. EVAR with TREO seems to be safe and feasible with satisfactory early surgical results. However, these investigations was supported by inside of IFU, too small cohorts, or limited to brief follow-up. Mid-term outcome of TREO reported from overseas seems to be favorable in terms of the reasonable protective effects on sac shrinkage due to new generation features. Therefore, further long-term evaluation is necessary.