Meridian - Development and validation of an innovative fenestrated endovascular stent graft for aortic aneurysm repair

腹主动脉瘤（AAA）每年在英格兰和威尔士造成约6000人死亡，在全球造成约17.5万人死亡。由于人口老龄化，这些数字可能会增加。AAAs发生在主动脉穿过腹部时，可能发生在任何年龄，但最常见于患者年龄，尤其是60岁以上。这种情况是由主动脉壁削弱引起的，与多种风险因素有关，包括年龄、动脉粥样硬化、冠心病、家族史和遗传，以及吸烟等生活方式因素。从历史上看，开放式手术是通过在主动脉凸起部分上下缝人工导管来修复AAA，这是一种具有挑战性的手术，风险和死亡率都高于开放式心脏手术。最近，包括血管内移植（EVAR）在内的微创手术已经发展起来，大大降低了患者的风险。然而，患者血管的个体解剖结构可能会给EVAR带来技术挑战，因为约50%的AAAs患者的解剖结构不适合使用标准血管内移植物治疗。为了克服这个问题，对于AAA靠近关键血管的患者，已经开发了开窗血管内移植物（FEVAR）。FEVAR装置上有小孔，允许血液流向靠近AAA的关键器官。对于那些可能不适合血管内修复的患者来说，这是一种相当普遍的治疗方法。FEVAR装置相对较大，而且往往与妇女和某些族裔群体的安全治疗不相容，从而使其处于不利地位。Lombard将开发一种新的开窗移植产品（Meridian），为具有挑战性的解剖结构提供解决方案，并为血管狭窄的患者提供FEVAR；由于相对于任何竞争对手的设备，它的尺寸要窄得多，因此有可能显著增加可治疗患者的多样性。子午线是一项突破性的医学创新：*增加了对严重血管疾病，女性和非高加索人群的适用性。*产道直径减小导致血管损伤和并发症发生率降低。*扩大该设备的使用范围，包括髂动脉瘤的治疗。*更少的肢体缺血和更容易的插入允许在局部麻醉下进行更多手术，从而减少手术时间和住院时间。

Abdominal aortic aneurysm (AAA) causes ~6000 deaths/year in England and Wales, and \>175 000 deaths globally. These figures will likely increase due to our ageing population.AAAs occur in the aorta as it passes through the abdomen and may occur at any age but are most common as patients age, especially beyond 60 years of age. The condition is caused by weakening of the aortic wall and is associated with multiple risk factors including age, atherosclerosis, coronary heart disease, family history and genetics, plus lifestyle factors such as smoking.Historically, open surgery was used to repair AAA using artificial tubes sewn inside the aorta above and below the bulging section, a challenging procedure with many risks and mortality rates higher than open heart surgery.More recently, minimally invasive procedures involving endovascular grafting (EVAR) have been developed which significantly reduce the risks for patients. However, the individual anatomy of the patient's blood vessels can create technical challenges for EVAR as ~50% of patients with AAAs have anatomy that is not ideal for treatment using standard endovascular grafts.To overcome this, fenestrated endovascular grafts (FEVAR) have been developed for patients where the AAA gets close to key blood vessels. FEVAR devices have holes created in them to allow blood to flow to key organs close to the AAA. This is now a fairly common treatment for patients who may not otherwise be candidates for endovascular repair. FEVAR devices are relatively large and are often not compatible with safe treatment for women and some ethnic groups, thus disadvantaging them.Lombard will develop a new fenestrated graft product (Meridian) which provides a solution for challenging anatomies and enables FEVAR for patients with narrow blood vessels; it has the potential to significantly increase the diversity of patients that can be treated due to its much narrower size relative to any competitor device.Meridian is a ground-breaking medical innovation by:\*Increased applicability in those with severe vascular disease, females, and non-Caucasian groups.\*Reduced delivery diameter leads to lower vessel trauma and complication rates.\*Extending the use of the device to include the treatment of iliac aneurysms.\*Less limb ischaemia and easier insertion allows more procedures under local anaesthetic which reduces operative times and hospital stays.