Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA.
Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, CA.
J Vasc Surg. 2023 Oct;78(4):902-911. doi: 10.1016/j.jvs.2023.05.032. Epub 2023 May 24.
This study quantified respiratory-induced dynamics of branch vessels before and after thoracoabdominal aortic aneurysm (TAAA) branched endovascular aneurysm repair (bEVAR).
Patients with TAAA were recruited prospectively and treated with bEVAR, predominantly with Zenith t-Branch and BeGraft Peripheral PLUS bridging stents. Using SimVascular software, three-dimensional geometric models of the vessels and implants were constructed from computed tomography angiograms during both inspiratory and expiratory breath-holds, preoperatively and postoperatively. From these models, branch take-off angles, end-stent angles (transition from distal end of stent to native artery), and curvatures were computed. Paired, two-tailed t tests were performed to compare inspiratory vs expiratory geometry and pre- vs postoperative deformations.
We evaluated 52 (12 celiac arteries [CA], 15 superior mesenteric arteries [SMA], and 25 renal arteries [RA]) branched renovisceral vessels with bridging stents in 15 patients. Implantation of bridging stents caused branch take-off angle to shift inferiorly in the SMA (P = .015) and RA (P = .014) and decreased the respiratory-induced branch angle motion in the CA and SMA by approximately 50%. End-stent angle increased from before to after bEVAR for the CA (P = .005), SMA (P = .020), and RA (P < .001); however, respiratory-induced deformation was unchanged. Bridging stents did not experience significant bending owing to respiration.
The decrease in respiratory-induced deformation of branch take-off angle from before to after bEVAR should decrease the risk of device disengagement and endoleak. The unchanging respiratory-induced end-stent bending, from before to after bEVAR, means that bEVAR maintains native vessel dynamics distal to the bridging stents. This factor minimizes the risk of tissue irritation owing to respiratory cycles, boding well for branch vessel patency. The longer bridging stent paths associated with bEVAR may enable smoother paths subject to less dynamic bending, and potentially lower fatigue risk, compared with fenestrated EVAR.
本研究量化了胸主动脉腹主动脉瘤（TAAA）分支血管内修复（bEVAR）前后呼吸引起的分支血管动力学变化。
前瞻性招募 TAAA 患者，并采用 bEVAR 治疗，主要采用 Zenith t-分支和 BeGraft 外周 PLUS 桥接支架。使用 SimVascular 软件，根据术前和术后吸气和呼气屏气期间的 CT 血管造影，构建血管和植入物的三维几何模型。从这些模型中，计算分支起始角度、末端支架角度（支架末端到原生动脉的过渡）和曲率。进行配对双侧 t 检验，比较吸气相与呼气相的几何形状和术前与术后的变形。
我们评估了 15 名患者的 52 个（12 个腹腔动脉[CA]、15 个肠系膜上动脉[SMA]和 25 个肾动脉[RA]）分支内脏血管的桥接支架。桥接支架的植入导致 SMA（P=0.015）和 RA（P=0.014）中的分支起始角度向下转移，并使 CA 和 SMA 中的呼吸引起的分支角度运动减少约 50%。CA（P=0.005）、SMA（P=0.020）和 RA（P<0.001）的末端支架角度从 bEVAR 前到后增加；然而，呼吸引起的变形保持不变。桥接支架由于呼吸没有经历明显的弯曲。
bEVAR 前后呼吸引起的分支起始角度变形的减少，应降低器械脱离和内漏的风险。bEVAR 前后，呼吸引起的末端支架弯曲保持不变，这意味着桥接支架远端的原生血管动力学保持不变。这一因素最大限度地减少了由于呼吸周期引起的组织刺激的风险，有利于分支血管通畅。与开窗 EVAR 相比，bEVAR 较长的桥接支架路径可能会使路径更平滑，受动态弯曲的影响更小，潜在的疲劳风险更低。
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