Influence of measurement and sizing techniques in thoracic endovascular aortic repair on outcome in acute complicated type B aortic dissections.
Aged
Aortic Dissection
/ complications
Aorta, Thoracic
/ diagnostic imaging
Aortic Aneurysm, Thoracic
/ complications
Aortography
/ methods
Blood Vessel Prosthesis
/ adverse effects
Blood Vessel Prosthesis Implantation
/ adverse effects
Endovascular Procedures
/ adverse effects
Humans
Middle Aged
Postoperative Complications
/ etiology
Retrospective Studies
Stents
/ adverse effects
Treatment Outcome
Aortic stent graft
Morphological assessment
Sizing
TEVAR
Type B aortic dissection
Journal
Interactive cardiovascular and thoracic surgery
ISSN: 1569-9285
Titre abrégé: Interact Cardiovasc Thorac Surg
Pays: England
ID NLM: 101158399
Informations de publication
Date de publication:
31 03 2022
31 03 2022
Historique:
received:
15
07
2021
revised:
16
08
2021
accepted:
26
09
2021
pubmed:
18
11
2021
medline:
5
4
2022
entrez:
17
11
2021
Statut:
ppublish
Résumé
Thoracic endovascular aortic repair (TEVAR) is the first-line therapy in acute complicated type B aortic dissections (cTBAD). Nevertheless, no evidence-based consensus on the optimal measurement technique and sizing for TEVAR in cTBAD exists. The aim was to evaluate how different measurement and sizing techniques for TEVAR affect long-term outcomes. Retrospective analysis investigating the association between sizing and postoperative results after TEVAR in patients with cTBAD, treated between January 2003 and December 2020. Diameter measurements were performed perpendicular to a centreline in pre-interventional Computed tomography angiographies. Oversizing was determined by measuring aortic diameter in zone 2 of the aortic arch in relation to the implanted stent graft, and categorized into 2 sizing groups (≤10% and >10%). The primary outcome was freedom from aortic-related events. Secondary outcomes included mortality and a comparison of 3 alternative measurement techniques considering the estimated pre-dissection diameter. Fifty-seven patients (median age 69, interquartile range 59.6-78.2 years) were included. Stent graft oversizing by ≤10% showed a trend towards fewer aortic-related events hazard ratio 0.455 (95% confidence interval 0.128-1.624, P = 0.225).The 3 measurement techniques using the pre-dissection aortic diameter differed by a mean of 1.7-4.0 mm with a variability of up to 8.4 mm. In none of the 57 patients, the same stent graft would have been chosen based on the different measurement techniques using an oversizing ≤10%. TEVAR oversizing of ≤10% in patients with cTBAD might reduce aortic-related events up to 50%. Consensus on measurement techniques of the pre-dissection aortic diameter and stent graft sizing is of paramount importance.
Identifiants
pubmed: 34788425
pii: 6425634
doi: 10.1093/icvts/ivab300
pmc: PMC8972260
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
628-636Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
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