Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.
J Vasc Surg. 2014 Jan;59(1):80-8. doi: 10.1016/j.jvs.2013.07.098. Epub 2013 Oct 16.
Structural changes and incomplete endograft apposition to the aortic arch (bird-beak configuration) after thoracic endovascular aortic repair are poorly understood. The aim of this study was to analyze the morphologic changes, conformability, and angulation factors in patients who underwent stainless steel-based stent graft repair of thoracic aortic pathology.
From March 2011 to March 2012, the study enrolled 19 patients with aortic pathology requiring proximal fixation in zones 2 and 3 who underwent stent graft repair using Zenith Pro-Form TX2 stent grafts (Cook Medical, Bloomington, Ind). For comparison, another 19 patients who received Zenith Z-Trak stent grafts were selected from December 2009 to February 2011. Chest computed tomography scans were analyzed at baseline, and then at 1, 6, and 12 months postoperatively. Arch angulation and bird-beak configuration were evaluated according to sealing zones of attachment by Aquarius iNtuition software (TeraRecon, San Mateo, Calif).
The treated diseases included chronic type B aortic dissection in 17 patients and degenerative aneurysms in 21. Significant arch angle transformation was noted at the zone 2 level between the Pro-Form and Z-Trak treated groups (150° ± 11° vs 158° ± 6°; P = .033) and left subclavian artery level (152° ± 12° vs 160° ± 8°; P = .031) during 1 year of follow-up. The bird-beak configuration was detected in six patients (32%) in the Pro-Form group and in 11 (58%) in the Z-Trak group (P = .096) at 1 month, and in six (32%) in the Pro-Form group and in 14 (74%) in the Z-Trak group (P = .022) at 12 months. The mean bird-beak angle was significantly less in Pro-Form-treated patients at 1 month (5° ± 9° vs 15° ± 13°; P = .019) and at 1 year (6° ± 10° vs 18° ± 15°; P = .033). In the Pro-Form platform, a preoperative zone 2 angle <151.1° was a better estimation of the presence of a postoperative bird-beak configuration, with a sensitivity of 86% and specificity of 83%.
Aortic remodeling after stainless steel stent graft repair of thoracic aortic pathology is a continuous process. Significant arch angle transformation was discovered over the zone 2 and left subclavian artery levels. TX2 Pro-Form stent grafts improved arch conformation after 1 year of follow-up. Furthermore, in the patients with dissection, a preoperative distal arch angle of zone 2 was predictive of postoperative bird-beak configuration, regardless of whether they were treated with a Pro-Form stent graft.
胸主动脉腔内修复术后，主动脉弓结构改变和内漏（鸟嘴状）是尚未完全解决的问题。本研究旨在分析接受不锈钢基支架移植物修复胸主动脉病变的患者的形态学变化、顺应性和角度因素。
2011 年 3 月至 2012 年 3 月，19 例需要在 2 区和 3 区近端固定的主动脉病变患者接受了 Zenith Pro-Form TX2 支架移植物修复（库克医疗，印第安纳州布鲁明顿）。为了比较，另从 2009 年 12 月至 2011 年 2 月选择了 19 例接受 Zenith Z-Trak 支架移植物的患者。基线时和术后 1、6、12 个月进行胸部 CT 扫描分析。使用 Aquarius iNtuition 软件（加利福尼亚州圣马特奥的泰雷康）根据附着密封区评估弓角度和鸟嘴状结构。
治疗疾病包括慢性 B 型主动脉夹层 17 例，退行性动脉瘤 21 例。Pro-Form 和 Z-Trak 治疗组在 2 区水平的主动脉弓角变化显著（150°±11° vs 158°±6°；P=0.033）和左锁骨下动脉水平（152°±12° vs 160°±8°；P=0.031），随访 1 年。Pro-Form 组 6 例（32%）和 Z-Trak 组 11 例（58%）（P=0.096）在 1 个月时出现鸟嘴状结构，Pro-Form 组 6 例（32%）和 Z-Trak 组 14 例（74%）（P=0.022）在 12 个月时出现鸟嘴状结构。1 个月时，Pro-Form 治疗组的鸟嘴角明显较小（5°±9° vs 15°±13°；P=0.019），1 年时（6°±10° vs 18°±15°；P=0.033）。在 Pro-Form 平台上，术前 2 区角度<151.1°是术后出现鸟嘴状结构的更好预测指标，其灵敏度为 86%，特异性为 83%。
胸主动脉病变不锈钢支架移植物修复后的主动脉重塑是一个持续的过程。在 2 区和左锁骨下动脉水平发现明显的弓角变化。TX2 Pro-Form 支架移植物在 1 年随访后改善了弓的形态。此外，在夹层患者中，术前 2 区远端弓角可预测术后鸟嘴状结构，无论其是否接受 Pro-Form 支架移植物治疗。
