Impact of Thoracic Endovascular Aortic Repair on Pulsatile Circumferential and Longitudinal Strain in Patients With Aneurysm

Nauta, Foeke J.H.; Bogerijen, Guido H.W. van; Trentin, Chiara; Conti, Michele; Auricchio, Ferdinando; Moll, Frans L.; Herwaarden, Joost A. van; Trimarchi, Santi

doi:10.1177/1526602816687086

Cited by 16 publications

(11 citation statements)

References 31 publications

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“…7 Animal models have linked compliance mismatch between prosthetic endovascular grafts and the native descending aorta to postprocedure complications such as dissection, aneurysmal dilatation, and rupture distal to the repair. 6,23,24 Nauta et al 25 assessed the impact of thoracic endovascular aortic repair on aortic strain using cardiac gated computed tomography and found that implantation of the prosthetic stent graft was associated with increased pulsatile longitudinal strain and circumferential strain proximal and distal to stented aortic segments. The authors hypothesised that this may contribute to stent graft related complications such as retrograde dissection, aneurysm formation, and rupture.…”

Section: Discussionmentioning

confidence: 99%

Immediate Impact of Prosthetic Graft Replacement of the Ascending Aorta on Circumferential Strain in the Descending Aorta

Rong

Palumbo

Rahouma

et al. 2019

European Journal of Vascular and Endovascular Surgery

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The results of this study demonstrate graft induced increases in circumferential deformation and distensibility in the native descending aorta in the presence of unchanged haemodynamics and stroke volume after proximal aortic graft replacement, suggesting that replacing native aorta with a graft increases pulse pressure and energy propagation downstream to the graft. This observation may have important clinical implications and may be a mechanism contributing to the reported risk of aneurysm formation or expansion, dissection, or rupture of the aorta distal to graft. Objectives: Prosthetic replacement of the ascending aorta (AA) can potentially modify energy propagation to the distal aorta and contribute to adverse aortic remodelling. This preliminary study employed intra-operative transoesophageal echocardiography (TOE) to assess the immediate impact of prosthetic graft replacement of the AA on circumferential strain in the descending aorta. Methods: Intra-operative TOEs in patients undergoing AA graft replacement were analysed for circumferential strain, fractional area change (FAC), dimensions (end diastolic area [EDA], and end systolic area [ESA]) in the descending aorta immediately before and after graft replacement. Deformation was assessed via global peak circumferential aortic strain (CAS), together with pulse pressure corrected strain, time to peak strain (TTP), and aortic distensibility. Results: Forty-five patients undergoing AA replacement with prosthetic graft (91% elective) were studied. Following grafting, descending thoracic aortic circumferential strain increased (6.3 AE 2.8% vs. 8.9 AE 3.4%, p ¼ .001) paralleling distensibility (5.7 [3.7e8.6] 10 À3 mmHg vs. 8.5 [6.4e12.4] 10 À3 mmHg, p < .001). Despite slight increments in post graft left ventricular ejection fraction (LVEF) (52.3 AE 10.8% vs. 55.0 AE 11.9, p < .001), stroke volume was similar (p ¼ .41), and magnitude of increased strain did not correlate with change in stroke volume (r ¼ À.03, p ¼ .86), LVEF (r ¼ .18, p ¼ .28), or pulse pressure (r ¼ .28, p ¼ .06). Descending aortic size (EDA 4 [2.7e4.6] cm 2 vs. 3.7 [2.5e5] cm 2 , p ¼ .89; ESA 4.3 [3.2e5.3] cm 2 vs. 4.5 [3.3e5.8] cm 2 , p ¼ .14) was similar pre-and post graft. In subgroup analysis, patients with cystic medial necrosis had a significantly higher post procedure CAS than patients with atherosclerotic aneurysms (9.7 AE 3.5% vs. 7.0 AE 2.3%, p ¼ .03). Conclusions: Prosthetic graft replacement of the AA increases immediate aortic circumferential strain of the descending aorta, particularly in patients with cystic medial necrosis. Our findings suggest that grafts augment energy transfer to the distal aorta, a potential mechanism for progressive distal aortic dilation and/or dissection.

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Section: Discussionmentioning

confidence: 99%

Immediate Impact of Prosthetic Graft Replacement of the Ascending Aorta on Circumferential Strain in the Descending Aorta

Rong

Palumbo

Rahouma

et al. 2019

European Journal of Vascular and Endovascular Surgery

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“…Based on a previous aortic DENSE study from healthy adult volunteers, 12 this range would be consistent with aortic strains from the majority of healthy adults over 35 years of age. However, for future applications in the assessment of aortopathies such as aneurysms and dissections, aortic DENSE must quantify focal and/or generalized stiffening that can yield circumferential strains as low as 1%–5% 29–31 . Future tests with improvement in the strength and variability of the phantoms may allow testing over a broader range of strains, including focused evaluations of stiff phantoms with strains <2% to mimic aortopathies and more compliant phantoms with strains ≥10% to mimic young aortas.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Validation of Regional Circumferential Strain Assessment in a Phantom Aortic Model Using Cine Displacement Encoding With Stimulated Echoes MRI

Wilson

Islam

Oshinski

2021

Magnetic Resonance Imaging

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Background: A novel application of cine Displacement ENcoding with Stimulated Echoes Magnetic Resonance Imaging (DENSE MRI) has recently been described to assess regional heterogeneities in circumferential strain around the aortic wall in vivo; however, validation is first required for successful clinical translation. Purpose: To validate the quantification of regional circumferential strain around the wall of an aortic phantom using DENSE MRI. Study Type: In vitro phantom study. Population: Three polyvinyl alcohol aortic phantoms with eight axially oriented nitinol wires embedded evenly around the walls. Field Strength/Sequence: 3 T; gradient-echo aortic DENSE MRI with spiral cine readout, gradient-echo phase-contrast MRI (PCMR) with Cartesian cine readout. Assessment: Phantoms were connected to a pulsatile flow loop and peak DENSE-derived regional circumferential Green strains at 16 equally spaced sectors around the wall were assessed according to previously published algorithms. "True" regional circumferential strains were calculated by manually tracking displacements of the nitinol wires by two independent observers. Normalized circumferential strains (NCS) were calculated by dividing regional strains by the mean strain. Finally, DENSE-derived regional strain was corrected by multiplying regional DENSE NCS by the mean strain calculated from the diameter change on the PCMR. Statistical Tests: One-sample t-test, Paired-sample t-test, and analysis of variance with Bonferroni correction, coefficient of variation (CoV), Bland-Altman analysis; P < 0.05 was considered statistically significant. Results: Aortic DENSE MRI significantly overestimated circumferential strain compared to the wire-tracking method (mean difference and SD 0.030 AE 0.014, CoV 0.31). However, NCS demonstrated good agreement between DENSE and wiretracking data (mean difference 0.000 AE 0.172, CoV 0.15). After correcting the DENSE-derived regional strain, the mean difference in regional circumferential strain between DENSE and wire-tracking was significantly reduced to 0.006 AE 0.008, and the CoV was reduced to 0.18. Data Conclusion: For aortic phantoms with mild spatial heterogeneity in circumferential strain, the previously published aortic DENSE MRI technique successfully assessed the regional NCS distribution but overestimated the mean strain. This overestimation is correctable by computing a more accurate mean circumferential strain using a separate cine scan. Level of Evidence: 2 Technical Efficacy: Stage 2

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“…Strain causes alterations that can result in mechanical stress, causing dSINE which leads to pseudoaneurysm. 8,20,21 This is seen especially at the transition zones between the rigid stent graft and the fragile aortic wall. The dissection membrane of acute dissections is approximately 15 times more prone to dSINE development compared with that of chronic dissections, and might therefore be at particular risk.…”

Section: Discussionmentioning

confidence: 99%

Distal Stent Graft Induced New Entry: Risk Factors in Acute and Chronic Type B Aortic Dissections

Lortz

Leinburger

Tsagakis

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS To reduce the risk of distal stent graft induced new entry (dSINE), the use of tapered stent grafts should be considered in cases with expected high distal oversizing, especially in acute aortic dissections. If dSINE development occurs, patients require special attention in terms of follow up regarding the need for potential reintervention. Reasons for re-intervention are mostly impending rupture and dSINE growth. However, dSINE has a good prognosis after interventional treatment if discovered early enough. Long term follow up after reinterventions shows mostly satisfying results, including that additional re-intervention is not necessary even after years. Objectives: Distal stent graft induced new entry (dSINE) is a rare complication associated with acute and chronic dissections after thoracic endovascular aortic repair (TEVAR) and is linked to a high re-intervention rate. The potential predicting risk factors for dSINE and long term outcome of patients after re-intervention were analysed. Methods: This single centre, retrospective study included patients undergoing TEVAR. Multivariable analysis was used to test important interventional parameters such as distal oversizing (dOS), taper ratio (TR), angle between distal stent graft and aorta, acute dissection and stent graft length. Re-intervention characteristics were analysed and further long term follow up after re-intervention were evaluated. Results: One hundred and eighty-five patients were analysed with acute (n ¼ 77) and chronic (n ¼ 108) dissections after TEVAR with an average follow up of 68.9 AE 32.5 months. During follow up, 12 (6.5%) patients developed dSINE after a median of 22.2 AE 20.7 months. Acute dissection was identified as a major predicting factor for dSINE development (15.8 fold increased odds), followed by increased dOS and TR. The re-intervention rate was higher in the dSINE group (83% vs. 20%, p ¼ .001), but results indicated that no further re-intervention was needed and no new endoleak development occurred up to a mean follow up of 60.7 AE 54.8 months. No dSINE was seen in association with tapered stent grafts. Conclusions: Acute aortic dissection was found to be the major predicting factor for dSINE development, followed by increased dOS and TR. The use of tapered stent grafts might be beneficial for patients with high expected dOS and TR. In the rare case of dSINE occurrence, even when re-intervention is required, the long term prognosis is good.

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Impact of Thoracic Endovascular Aortic Repair on Pulsatile Circumferential and Longitudinal Strain in Patients With Aneurysm

Cited by 16 publications

References 31 publications

Immediate Impact of Prosthetic Graft Replacement of the Ascending Aorta on Circumferential Strain in the Descending Aorta

Immediate Impact of Prosthetic Graft Replacement of the Ascending Aorta on Circumferential Strain in the Descending Aorta

In Vitro Validation of Regional Circumferential Strain Assessment in a Phantom Aortic Model Using Cine Displacement Encoding With Stimulated Echoes MRI

Distal Stent Graft Induced New Entry: Risk Factors in Acute and Chronic Type B Aortic Dissections

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