Aortic morphometry at endograft position as assessed by 3D image analysis affects risk of type I endoleak formation after TEVAR

• Verfasst von: Kotelis, Drosos [VerfasserIn]
• Verfasst von: Brenke, Carolin [VerfasserIn]
• Verfasst von: Wörz, Stefan [VerfasserIn]
• Verfasst von: Rengier, Fabian [VerfasserIn]
• Verfasst von: Rohr, Karl [VerfasserIn]
• Verfasst von: Kauczor, Hans-Ulrich [VerfasserIn]
• Verfasst von: Böckler, Dittmar [VerfasserIn]
• Verfasst von: Tengg-Kobligk, Hendrik von [VerfasserIn]
• Titel: Aortic morphometry at endograft position as assessed by 3D image analysis affects risk of type I endoleak formation after TEVAR
• Verf.angabe: Drosos Kotelis, Carolin Brenke, Stefan Wörz, Fabian Rengier, Karl Rohr, Hans-Ulrich Kauczor, Dittmar Böckler, Hendrik von Tengg-Kobligk
• E-Jahr: 2015
• Jahr: 22 February 2015
• Umfang: 7 S.
• Fussnoten: Gesehen am 17.08.2017
• Titel Quelle: Enthalten in: Langenbeck's archives of surgery
• Ort Quelle: Berlin : Springer, 1948
• Jahr Quelle: 2015
• Band/Heft Quelle: 400(2015), 4, Seite 523-529
• ISSN Quelle: 1435-2451
• DOI: doi:10.1007/s00423-015-1291-1
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1562523422

Abstract

PurposeThe purpose of this study was to identify morphologic factors affecting type I endoleak formation and bird-beak configuration after thoracic endovascular aortic repair (TEVAR).MethodsComputed tomography (CT) data of 57 patients (40 males; median age, 66 years) undergoing TEVAR for thoracic aortic aneurysm (34 TAA, 19 TAAA) or penetrating aortic ulcer (n = 4) between 2001 and 2010 were retrospectively reviewed. In 28 patients, the Gore TAG® stent-graft was used, followed by the Medtronic Valiant® in 16 cases, the Medtronic Talent® in 8, and the Cook Zenith® in 5 cases. Proximal landing zone (PLZ) was in zone 1 in 13, zone 2 in 13, zone 3 in 23, and zone 4 in 8 patients. In 14 patients (25 %), the procedure was urgent or emergent. In each case, pre- and postoperative CT angiography was analyzed using a dedicated image processing workstation and complimentary in-house developed software based on a 3D cylindrical intensity model to calculate aortic arch angulation and conicity of the landing zones (LZ).ResultsPrimary type Ia endoleak rate was 12 % (7/57) and subsequent re-intervention rate was 86 % (6/7). Left subclavian artery (LSA) coverage (p = 0.036) and conicity of the PLZ (5.9 vs. 2.6 mm; p = 0.016) were significantly associated with an increased type Ia endoleak rate. Bird-beak configuration was observed in 16 patients (28 %) and was associated with a smaller radius of the aortic arch curvature (42 vs. 65 mm; p = 0.049). Type Ia endoleak was not associated with a bird-beak configuration (p = 0.388). Primary type Ib endoleak rate was 7 % (4/57) and subsequent re-intervention rate was 100 %. Conicity of the distal LZ was associated with an increased type Ib endoleak rate (8.3 vs. 2.6 mm; p = 0.038).ConclusionsCT-based 3D aortic morphometry helps to identify risk factors of type I endoleak formation and bird-beak configuration during TEVAR. These factors were LSA coverage and conicity within the landing zones for type I endoleak formation and steep aortic angulation for bird-beak configuration.