Device Conformability and Morphological Assessment After TEVAR for Aortic Type B Dissection: A Single-Centre Experience with a Conformable Thoracic Stent-Graft Design

Abstract

BackgroundThe aim of this study was to analyze device conformability in TEVAR of acute and chronic (a/c) type B aortic dissections (TBAD) using the Gore Conformable Thoracic Aortic Stent-graft (CTAG).Material/MethodsFrom January 1997 to February 2014, a total of 90 out of 405 patients in our center received TEVAR for TBAD. Since November 2009, 23 patients (16 men; median age: 62 years) were treated with the CTAG. Indications were complicated aTBAD in 15 (65%) and expanding cTBAD in 8 (35%) patients. Primary endpoints were the assessment of device conformability by measuring the distance (D) from the radiopaque gold band marker (GM) at the proximal CTAG end to the inner curvature (IC) of the arch on parasagittal multiplanar reformations of CT angiography, as well as the evaluation of aortic diameter changes following TEVAR. Median follow-up was 13.3 months (range: 2 days to 35 months).ResultsPrimary and secondary success rates were 91.3% (21/23) and 95.6% (22/23), respectively. There was 1 type Ia endoleak, retrograde dissection or primary conversion was not observed. Median GM-IC-D was 0 mm (range: 0 mm to 10 mm). GM-IC-D was associated with zone 2 placement compared to zone 3 (P=0.036). There was no association between GM-IC-D formation and arch type. In aTBAD cases the true lumen significantly increased after TEVAR (P=0.017) and the false lumen underwent shrinkage (P=0.025). In cTBAD patients the false lumen decreased after TEVAR (P=0.036).ConclusionsThe CTAG shows favorable conformability and wall apposition in challenging arch pathologies such as TBAD.

Impact of the Bird-Beak Configuration on Postoperative Outcome After Thoracic Endovascular Aortic Repair: A Meta-analysis

“…Proximal landing zones 2 and 3 were also found to be associated with an increased risk of the BBC. 1,2,9,19,22 One study 18 reported the BBC as a common occurrence when the endograft was deployed in an ascending aortic Dacron graft during type II hybrid arch repair.…”

“…Yet, displacement forces are greater in aneurysmal aortas compared with healthy aortas (ie, nondilated aortas such as in trauma patients) in zone 3, 7 and therefore clinical outcomes may vary based on the indication for TEVAR and the choice of the proximal landing zone. Among the potential determinants of the BBC analyzed in the literature, specific anatomic risk factors are the ones most consistently reported, namely proximal landing zones 2 and 3 1,2,9,19,22 and aortic angulation. [16][17][18][19]24,25,28 Of note, these features are often associated because zones 2 and 3 in a type III arch configuration are characterized by severe angulation and tortuosity.…”

“…The time between the index TEVAR and the occurrence of the complication related to the BBC ranged between 0 and 72 months. 26,29 Twelve studies [1][2][3]14,15,[17][18][19][20]22,25,29 reported detailed information to analyze the impact of the BBC on postoperative outcome and were included in the quantitative analysis. Complications occurred in 14.7% (95% CI 7.4% to 27.3%) of patients with BBC and in 6.3% (95% CI 2.5% to 15.4%) of patients without BBC (Table 2).…”

Endovascular ascending aortic repair in type A dissection: A systematic review

“…These topics will be addressed below. 73,74 Alternatively, a transapical, transcarotid, or transaxillary approach offer deployment strategies closer to the ascending aorta when compared to the transfemoral approach. Nonetheless, each of these approaches carry distinct risks.…”

Aortic Valve Perforation During Endovascular Repair of an Abdominal Aortic Aneurysm—A Case Report

“…This approach is used to position the device parallel to the outer curve in cases with an acute angled landing zone by pushing a stiff wire. 2 -4 A 260-cm Amplatz Super Stiff™ wire (Cook, Bloomington, U.S.A.) was used to advance the delivery system of the main body. The wire tip was placed just above the aortic valve beforehand.…”