Dynamic morphology of the ascending aorta and its implications for proximal landing in thoracic endovascular aortic repair

• Verfasst von: Skrypnik, Denis [VerfasserIn]
• Verfasst von: Ante, Marius [VerfasserIn]
• Verfasst von: Meisenbacher, Katrin [VerfasserIn]
• Verfasst von: Kronsteiner, Dorothea [VerfasserIn]
• Verfasst von: Hagedorn, Matthias [VerfasserIn]
• Verfasst von: Rengier, Fabian [VerfasserIn]
• Verfasst von: André, Florian [VerfasserIn]
• Verfasst von: Frey, Norbert [VerfasserIn]
• Verfasst von: Böckler, Dittmar [VerfasserIn]
• Verfasst von: Bischoff, Moritz [VerfasserIn]
• Titel: Dynamic morphology of the ascending aorta and its implications for proximal landing in thoracic endovascular aortic repair
• Verf.angabe: Denis Skrypnik, Marius Ante, Katrin Meisenbacher, Dorothea Kronsteiner, Matthias Hagedorn, Fabian Rengier, Florian André, Norbert Frey, Dittmar Böckler and Moritz S. Bischoff
• Jahr: 2023
• Umfang: 10 S.
• Fussnoten: Gesehen am 04.05.2023 ; Published 21 December 2022
• Titel Quelle: Enthalten in: Journal of Clinical Medicine
• Ort Quelle: Basel : MDPI, 2012
• Jahr Quelle: 2023
• Band/Heft Quelle: 12(2023), 1, Artikel-ID 70, Seite 1-10
• ISSN Quelle: 2077-0383
• DOI: doi:10.3390/jcm12010070
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: angiography
• Sach-SW: diastole evaluation
• Sach-SW: dimension changes
• Sach-SW: dissection
• Sach-SW: distensibility
• Sach-SW: dynamic morphology of ascending aorta
• Sach-SW: endograft of ascending aorta
• Sach-SW: insight
• Sach-SW: landing zone morphology
• Sach-SW: neck
• Sach-SW: strain
• Sach-SW: systole
• Sach-SW: TEVAR of ascending aorta
• Sach-SW: thoracic endovascular aortic repair
• K10plus-PPN: 1844602362

Abstract

In this study, we assessed the dynamic segmental anatomy of the entire ascending aorta (AA), enabling the determination of a favorable proximal landing zone and appropriate aortic sizing for the most proximal thoracic endovascular aortic repair (TEVAR). Methods: Patients with a non-operated AA (diameter < 40 mm) underwent electrocardiogram-gated computed tomography angiography (ECG-CTA) of the entire AA in the systolic and diastolic phases. For each plane of each segment, the maximum and minimum diameters in the systole and diastole phases were recorded. The Wilcoxon signed-rank test was used to compare aortic size values. Results: A total of 100 patients were enrolled (53% male; median age 82.1 years; age range 76.8-85.1). Analysis of the dynamic plane dimensions of the AA during the cardiac cycle showed significantly higher systolic values than diastolic values (p < 0.001). Analysis of the proximal AA segment showed greater distal plane values than proximal plane values (p < 0.001), showing a reversed funnel form. At the mid-ascending segment, the dynamic values did not notably differ between the distal plane and the proximal segmental plane, demonstrating a cylindrical form. At the distal segment of the AA, the proximal plane values were larger than the distal segmental plane values (p < 0.001), thus generating a funnel form. Conclusions: The entire AA showed greater systolic than diastolic aortic dimensions throughout the cardiac cycle. The mid-ascending and distal-ascending segments showed favorable forms for TEVAR using a regular cylindrical endograft design. The most proximal segment of the AA showed a pronounced conical form; therefore, a specific endograft design should be considered.