A study of aortic dimension in type B aortic dissection

Abstract

Difference between arch diameter and true lumen diameter in the descending aorta was studied in patients with type B aortic dissection. The diameters of the aortic arch (Proximal ) and mid-descending aorta (Distal ) were measured on computer tomography angiography (CTA) in 20 healthy adults. Forty-two patients with type B aortic dissection who underwent endovascular repair were divided into two groups: an acute group (23 patients) and a chronic group (19 patients). The diameters of the arch (Proximal ) and the true lumen of the mid-descending aorta (Distal ) were measured on digital subtraction angiography (DSA) and CTA. The taper ratio was defined as (Proximal -Distal )/(Proximal )x100%. In the control group, the taper ratio was 13.0+/-4.7% on CTA. In the acute patients group, the taper ratio was 23.6+/-11.3% on DSA and 21.9+/-12.1% on CTA. In the chronic patients group, the taper ratio was 31.5+/-13.6% on DSA and 30.1+/-11.4% on CTA. In both acute and chronic type B aortic dissection, the aorta tapers significantly from arch to true lumen in the descending aorta. Stent-graft with tapered design may be a viable treatment option for endovascular repair of type B aortic dissection.

Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection

“…The authors noted that oversizing according to the aortic arch meant excessive oversizing for the distal true lumen and potentially causing rupture of the already dissected membrane. 37 Another aspect to be considered in assessment of the risk for SINE is the pathologic fragility of aortic wall. Marfan syndrome was well recognized for its effect on aortic wall weakness and a notable tendency to progressively involve the residual aorta after surgical or endovascular treatment for the primarily affected aortic segment.…”

Thoracic aortic aneurysm expansion due to late distal stent graft‐induced new entry

“…The aortic diameter of the proximal landing zone and the minimum and maximum diameters of true lumen, at the presumed level of the distal end of the stent, were measured. In addition, we measured the taper ratio of the aortic arch, defined as (proximal landing diameter—distal landing diameter)/proximal landing diameter . Oversizing ratios were calculated based on the known diameter of the stent‐graft used and the presumed proximal and distal landing zones measured before implantation.…”

Restrictive bare stent for prevention of stent graft-induced distal redissection after thoracic endovascular aortic repair for type B aortic dissection

“…The mismatch between the size of the stent graft, which was determined by the proximal landing zone, and the remarkably small diameter of the compressed true lumen of the distal descending aorta was suggested to contribute to the occurrence of the SIDR. 11,17 We have used the restrictive bare stent (RBS) technique to reduce this mismatch for more than 4 years, beginning in March 2007. The technique is to place the bare stent of proper size into the intended distal part of the endograft, prior to deployment of the stent graft.…”