Kotelis Drosos, Brenke Carolin, Wörz Stefan, Rengier Fabian, Rohr Karl, Kauczor Hans-Ulrich, Böckler Dittmar, von Tengg-Kobligk Hendrik
Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany,
Langenbecks Arch Surg. 2015 May;400(4):523-9. doi: 10.1007/s00423-015-1291-1. Epub 2015 Feb 22.
The purpose of this study was to identify morphologic factors affecting type I endoleak formation and bird-beak configuration after thoracic endovascular aortic repair (TEVAR).
Computed 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).
Primary 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).
CT-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.
本研究旨在确定影响胸主动脉腔内修复术（TEVAR）后I型内漏形成和鸟嘴样形态的形态学因素。
回顾性分析2001年至2010年间57例（40例男性；中位年龄66岁）因胸主动脉瘤（34例胸主动脉瘤，19例胸主动脉夹层动脉瘤）或穿透性主动脉溃疡（n = 4）接受TEVAR治疗患者的计算机断层扫描（CT）数据。28例患者使用了戈尔TAG®覆膜支架，16例使用美敦力勇士®，8例使用美敦力Talent®，5例使用库克天顶®。13例患者的近端锚定区（PLZ）位于1区，13例位于2区，23例位于3区，8例位于4区。14例患者（25%）的手术为急诊或紧急手术。在每种情况下，使用专用图像处理工作站和基于三维圆柱强度模型的内部开发软件对术前和术后CT血管造影进行分析，以计算主动脉弓角度和锚定区（LZ）的锥度。
原发性Ia型内漏发生率为12%（7/57），后续再次干预率为86%（6/7）。左锁骨下动脉（LSA）覆盖（p = 0.036）和PLZ的锥度（5.9对2.6 mm；p = 0.016）与Ia型内漏发生率增加显著相关。16例患者（28%）观察到鸟嘴样形态，其与主动脉弓曲率半径较小有关（42对65 mm；p = 0.049）。Ia型内漏与鸟嘴样形态无关（p = 0.388）。原发性Ib型内漏发生率为7%（4/57），后续再次干预率为100%。远端LZ的锥度与Ib型内漏发生率增加有关（8.3对2.6 mm；p = 0.038）。
基于CT的三维主动脉形态测量有助于识别TEVAR期间I型内漏形成和鸟嘴样形态的危险因素。这些因素包括I型内漏形成时LSA覆盖和锚定区内的锥度，以及鸟嘴样形态时陡峭的主动脉角度。
