Durable outcomes of thoracic endovascular aortic repair with Zenith TX1 and TX2 devices

Beach, Jocelyn M.; Kuramochi, Yuki; Brier, Corey; Roselli, Eric E.; Eagleton, Matthew J.

doi:10.1016/j.jvs.2016.11.029

Cited by 7 publications

(17 citation statements)

References 28 publications

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“…Histological and stereological techniques reveal significant spatial variations in constituent densities along the aorta, and morphological analyses show marked variation in wall layer thicknesses between intimal, medial and adventitial layers with increasing distance from the heart. Results presented on the regional heterogeneity of the aorta may aid in the understanding of the underlying causes for the differences in mortality following proximal compared with distal aortic stenting (Mart ın et al 2008;Bischoff et al 2016;Beach et al 2017;Concannon et al 2017;Conrad et al 2017). Additionally, the quantification and fitting of regional aortic microstructural data facilitates the development of next-generation finite element models that can potentially simulate the influence of regional aortic composition and microstructure on vessel biomechanics.…”

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confidence: 99%

Quantification of the regional bioarchitecture in the human aorta

et al. 2019

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Regional variance in human aortic bioarchitecture responsible for the elasticity of the vessel is poorly understood. The current study quantifies the elements responsible for aortic compliance, namely, elastin, collagen and smooth muscle cells, using histological and stereological techniques on human tissue with a focus on regional heterogeneity. Using donated cadaveric tissue, a series of samples were excised between the proximal ascending aorta and the distal abdominal aorta, for five cadavers, each of which underwent various staining procedures to enhance specific constituents of the wall. Using polarised light microscopy techniques, the orientation of collagen fibres was studied for each location and each tunical layer of the aorta. Significant transmural and longitudinal heterogeneity in collagen fibre orientations were uncovered throughout the vessel. It is shown that a von Mises mixture model is required accurately to fit the complex collagen fibre distributions that exist along the aorta. Additionally, collagen and smooth muscle cell density was observed to increase with increasing distance from the heart, whereas elastin density decreased. Evidence clearly demonstrates that the aorta is a highly heterogeneous vessel which cannot be simplistically represented by a single compliance value. The quantification and fitting of the regional aortic bioarchitectural data, although not without its limitations, including mean cohort age of 77.6 years, facilitates the development of next‐generation finite element models that can potentially simulate the influence of regional aortic composition and microstructure on vessel biomechanics.

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confidence: 99%

Quantification of the regional bioarchitecture in the human aorta

et al. 2019

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Section: Discussionmentioning

confidence: 99%

“…Almost 80% to 90% of patients with AD die in two to three weeks if left untreated [ 6 , 7 ]. Although AD most commonly presents with sudden and tearing chest, abdomen, or back pain, 5-10% of the patients remain asymptomatic; moreover, AD is detected as an incidental finding [ 8 ]. Patients with painless AD can present with other symptoms such as syncope [ 9 ], vomiting, amnesia [ 10 ], paraplegia [ 11 ], and stroke.…”

Section: Discussionmentioning

confidence: 99%

Incidental Finding of an Asymptomatic Aortic Dissection in a Patient With Catheterization Failure

Ahmad¹,

Aiman²,

Ali³

et al. 2022

Cureus

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Aortic dissection (AD) is an injury to the innermost layer of the aorta, leading to the formation of a false lumen. AD usually presents with tearing chest pain radiating to the back and is a medical emergency. Other common symptoms include abdominal pain, diaphoresis, loss of consciousness, shortness of breath, strokelike symptoms, or leg pain. Here, we present a rare case of an incidental finding of asymptomatic AD on computed tomography angiography performed after cardiac catheterization failure. The patient had a history of aortic aneurysm, hypertension, and heart failure. Appropriate imaging should be performed to rule out the possibility of AD in patients with risk factors and cardiac catheterization failure.

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“…( 2017 ). Furthermore, clinical studies report incidences of cardiac events in 34–45% of patients that undergo stenting of the thoracic aorta (Conrad et al 2017 ; Beach et al 2017 ; Bischoff et al 2016 ; Martín et al 2008 ). Such incidences are considerably lower in abdominally stented patients 6–12% (Atti et al 2018 ; Blankensteijn et al 1998 ; Barakat et al 2015 ; Dakour Aridi et al 2018 ).…”

Section: Discussion and Concluding Remarksmentioning

confidence: 99%

Influence of shape-memory stent grafts on local aortic compliance

Concannon

Moerman

Hynes

et al. 2021

Biomech Model Mechanobiol

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The effect of repair techniques on the biomechanics of the aorta is poorly understood, resulting in significant levels of postoperative complications for patients worldwide. This study presents a computational analysis of the influence of Nitinol-based devices on the biomechanical performance of a healthy patient-specific human aorta. Simulations reveal that Nitinol stent-grafts stretch the artery wall so that collagen is stretched to a straightened high-stiffness configuration. The high-compliance regime (HCR) associated with low diastolic lumen pressure is eliminated, and the artery operates in a low-compliance regime (LCR) throughout the entire cardiac cycle. The slope of the lumen pressure–area curve for the LCR post-implantation is almost identical to that of the native vessel during systole. This negligible change from the native LCR slope occurs because the stent-graft increases its diameter from the crimped configuration during deployment so that it reaches a low-stiffness unloading plateau. The effective radial stiffness of the implant along this unloading plateau is negligible compared to the stiffness of the artery wall. Provided the Nitinol device unloads sufficiently during deployment to the unloading plateau, the degree of oversizing has a negligible effect on the pressure–area response of the vessel, as each device exerts approximately the same radial force, the slope of which is negligible compared to the LCR slope of the native artery. We show that 10% oversizing based on the observed diastolic diameter in the mid descending thoracic aorta results in a complete loss of contact between the device and the wall during systole, which could lead to an endoleak and stent migration. 20% oversizing reaches the Dacron enforced area limit (DEAL) during the pulse pressure and results in an effective zero-compliance in the later portion of systole.

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Durable outcomes of thoracic endovascular aortic repair with Zenith TX1 and TX2 devices

Abstract: TEVAR is durable and associated with high long-term aneurysm-related survival. Long-term imaging follow-up remains critical to identify endoleaks or rare device durability issues, most of which can be monitored or managed with endovascular therapies.

Cited by 7 publications

References 28 publications

Quantification of the regional bioarchitecture in the human aorta

Quantification of the regional bioarchitecture in the human aorta

Incidental Finding of an Asymptomatic Aortic Dissection in a Patient With Catheterization Failure

Influence of shape-memory stent grafts on local aortic compliance

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