Risk Factor Analysis of Bird Beak Occurrence after Thoracic Endovascular Aortic Repair

Abstract

Assessment of proximal landing zone morphology to avoid deployment zones generating an aortic angle of over 50° can be recommended to improve aortic curvature apposition with the current available devices.

Thoracic aortic geometry correlates with endograft bird-beaking severity

“…9 Aortic geometry has previously been shown to influence the development of bird-beaking; however, the extent of its influence has not been clearly defined. 4,5,8 Whereas high curvature/angulation at the proximal landing zone has been known to influence bird-beaking, clear relationships between aortic geometry, bird-beak Table II. Preoperative aortic cross-sectional (CX) area, inner curvature, effective diameter, curvature  diameter, and intended graft oversizing at the proximal landing point (PLP) and postoperative bird-beak severity described by bird-beak length (BBL), bird-beak height (BBH), and bird-beak angle (BBA) severity, and subsequent type IA endoleak have heretofore been lacking.…”

“…It is thought to develop as a consequence of insufficient endograft conformability and hostile aortic geometry (notably, high aortic angulation and curvature) and may be mitigated through active control delivery systems (ie, the ability to orient the proximal endograft in situ). [4][5][6][7][8][9] Bird-beaking occurs frequently in TEVAR (44%) and is correlated with an increased risk of type IA endoleak in severe cases. 3 Evidence also suggests that severe bird-beaking may lead to premature material fatigue and contribute to device collapse and fracture.…”

A geometric reappraisal of proximal landing zones for thoracic endovascular aortic repair according to aortic arch types

“…[7][8][9] However, only heterogeneous definitions and methodology for measuring neck angulation have been reported thus far. 10,11 Preoperative planning for endovascular repair of the aortic arch is described based on the aortic arch map reported by Ishimaru. 12 This classification defines the proximal landing zones (0 to 4) as related to the origin of the supra-aortic vessels and indicates the requirement of a prophylactic rerouting of the involved aortic branches, which can be performed with a surgical extra-anatomic bypass 13 or with endovascular procedures with the use of fenestrated or branched endografts 14 or with the chimney technique.…”

Traumatic aortic injury: does the anatomy of the aortic arch influence aortic trauma severity?

“…There is an apparent need to extend the understanding of the biomechanics of the aortic arch in the current surgical era, in which endovascular devices are increasingly used to treat pathological conditions in this area of aorta. The shape of the aortic arch has an unquestionable influence on the occurrence of endoleak, bird-beaking, and even on the collapse of stent-grafts in TEVAR [ 7 , 25 , 26 ].…”