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

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.

[1]  G. White,et al.  Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. , 1997 .

[2]  Fumio Ishioka,et al.  Discriminant analysis of native thoracic aortic curvature: risk prediction for endoleak formation after thoracic endovascular aortic repair. , 2011, Journal of vascular and interventional radiology : JVIR.

[3]  P. Schoenhagen,et al.  Endoleaks following Endovascular Repair of Thoracic Aortic Aneurysm: Etiology and Outcomes , 2008, Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists.

[4]  J. Matsumura,et al.  Differences in aortic arch radius of curvature, neck size, and taper in patients with traumatic and aortic disease. , 2013, The Journal of surgical research.

[5]  J. Mckinsey,et al.  Reporting standards for thoracic endovascular aortic repair (TEVAR). , 2010, Journal of vascular surgery.

[6]  David M. Williams,et al.  Long-term results from a 12-year experience with endovascular therapy for thoracic aortic disease. , 2006, The Annals of thoracic surgery.

[7]  Karl Rohr,et al.  3-D Quantification of the Aortic Arch Morphology in 3-D CTA Data for Endovascular Aortic Repair , 2010, IEEE Transactions on Biomedical Engineering.

[8]  Po-Lin Chen,et al.  The impact of bird-beak configuration on aortic remodeling of distal arch pathology after thoracic endovascular aortic repair with the Zenith Pro-Form TX2 thoracic endograft. , 2014, Journal of vascular surgery.

[9]  R. Balm,et al.  Mid-term survival and costs of treatment of patients with descending thoracic aortic aneurysms; endovascular vs. open repair: a case-control study. , 2005, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[10]  D. C. Brewster,et al.  Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results. , 2006, Journal of vascular surgery.

[11]  Bhargav Raman,et al.  Impact of quantitatively determined native thoracic aortic tortuosity on endoleak development after thoracic endovascular aortic repair. , 2011, AJR. American journal of roentgenology.

[12]  D. Böckler,et al.  Endovascular repair of stent graft collapse by stent-protected angioplasty using a femoral-brachial guidewire. , 2008, Journal of vascular surgery.

[13]  D. Böckler,et al.  Reinterventions during midterm follow-up after endovascular treatment of thoracic aortic disease. , 2011, Journal of vascular surgery.

[14]  B. Starnes,et al.  Evaluation of the redesigned conformable GORE TAG thoracic endoprosthesis for traumatic aortic transection. , 2013, Journal of vascular surgery.

[15]  D. Böckler,et al.  Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aorta. , 2009, Journal of vascular surgery.

[16]  Jarrett Rosenberg,et al.  Factors Portending Endoleak Formation After Thoracic Aortic Stent-Graft Repair of Complicated Aortic Dissection , 2009, Circulation. Cardiovascular interventions.

[17]  W. Lee,et al.  Endovascular Abdominal Aortic Aneurysm Sizing and Case Planning Using the TeraRecon Aquarius Workstation , 2007, Vascular and endovascular surgery.

[18]  D. Böckler,et al.  Endografting in the aortic arch - does the proximal landing zone influence outcome? , 2010, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[19]  Karl Rohr,et al.  Segmentation and Quantification of Human Vessels Using a 3-D Cylindrical Intensity Model , 2007, IEEE Transactions on Image Processing.

[20]  Takuya Ueda,et al.  Incomplete endograft apposition to the aortic arch: bird-beak configuration increases risk of endoleak formation after thoracic endovascular aortic repair. , 2010, Radiology.