Frohlich Maxfield M, Suh Ga-Young, Bondesson Johan, Leineweber Matthew, Lee Jason T, Dake Michael D, Cheng Christopher P
Biomedical Engineering Department, San Jose State University, San Jose, Calif.
Department of Biomedical Engineering, California State University, Long Beach, Calif.
J Vasc Surg. 2020 Oct;72(4):1196-1205. doi: 10.1016/j.jvs.2019.11.045. Epub 2020 Feb 5.
Aortic geometry has been shown to influence the development of endograft malapposition (bird-beaking) in thoracic endovascular aortic repair (TEVAR), but the extent of this relationship lacks clarity. The aim of this study was to develop a reproducible method of measuring bird-beak severity and to investigate preoperative geometry associated with bird-beaking.
The study retrospectively analyzed 20 patients with thoracic aortic aneurysms or type B dissections treated with TEVAR. Computed tomography scans were used to construct three-dimensional geometric models of the preoperative and postoperative aorta and endograft. Postoperative bird-beaking was quantified with length, height, and angle; categorized into a bird-beak group (BBG; n = 10) and no bird-beak group (NBBG; n = 10) using bird-beak height ≥5 mm as a threshold; and correlated to preoperative metrics including aortic cross-sectional area, inner curvature, diameter, and inner curvature × diameter as well as graft diameter and oversizing at the proximal landing zone.
Aortic area (1002 ± 118 mm vs 834 ± 248 mm), inner curvature (0.040 ± 0.014 mm vs 0.031 ± 0.012 mm), and diameter (35.7 ± 2.1 mm vs 32.2 ± 4.9 mm) were not significantly different between BBG and NBBG; however, inner curvature × diameter was significantly higher in BBG (1.4 ± 0.5 vs 1.0 ± 0.3; P = .030). Inner curvature and curvature × diameter were significantly correlated with bird-beak height (R = 0.462, P = .041; R = 0.592, P = .006) and bird-beak angle (R = 0.680, P < .001; R = 0.712, P < .001).
TEVAR bird-beak severity can be quantified and predicted with geometric modeling techniques, and the combination of high preoperative aortic inner curvature and diameter increases the risk for development of TEVAR bird-beaking.
主动脉几何形态已被证明会影响胸主动脉腔内修复术（TEVAR）中血管腔内移植物贴壁不良（鸟嘴样改变）的发生，但这种关系的程度尚不清楚。本研究的目的是开发一种可重复的测量鸟嘴样改变严重程度的方法，并研究与鸟嘴样改变相关的术前几何形态。
本研究回顾性分析了20例接受TEVAR治疗的胸主动脉瘤或B型主动脉夹层患者。利用计算机断层扫描构建术前和术后主动脉及血管腔内移植物的三维几何模型。用长度、高度和角度对术后鸟嘴样改变进行量化；以鸟嘴样高度≥5 mm为阈值，分为鸟嘴样改变组（BBG；n = 10）和无鸟嘴样改变组（NBBG；n = 10）；并与术前指标相关联，包括主动脉横截面积、内曲率、直径、内曲率×直径以及移植物直径和近端锚定区的尺寸过大情况。
BBG组和NBBG组之间的主动脉面积（1002 ± 118 mm² 对 834 ± 248 mm²）、内曲率（0.040 ± 0.014 mm对0.031 ± 0.012 mm）和直径（35.7 ± 2.1 mm对32.2 ± 4.9 mm）无显著差异；然而，BBG组的内曲率×直径显著更高（1.4 ± 0.5对1.0 ± 0.3；P = .030）。内曲率和曲率×直径与鸟嘴样高度（R = 0.462，P = .041；R = 0.592，P = .006）和鸟嘴样角度（R = 0.680，P < .001；R = 0.712，P < .001）显著相关。
TEVAR鸟嘴样改变的严重程度可用几何建模技术进行量化和预测，术前主动脉高内曲率和直径的组合会增加TEVAR鸟嘴样改变发生的风险。
