University Aortic Centre Munich, LMU University Hospital, Munich, Germany; Department of Vascular Surgery, LMU University Hospital, Munich, Germany.
University Aortic Centre Munich, LMU University Hospital, Munich, Germany; Department of Cardiac Surgery, LMU University Hospital, Munich, Germany.
Eur J Vasc Endovasc Surg. 2024 Oct;68(4):456-466. doi: 10.1016/j.ejvs.2024.06.012. Epub 2024 Jun 13.
To evaluate sex based differences in ascending aorta and arch anatomy in patients with underlying proximal aortic disease and to evaluate their impact on feasibility for total endovascular repair with custom made, branched arch devices.
This was a retrospective cross sectional review of all patients undergoing open and or total endovascular arch repair due to distal ascending aorta and or aortic arch pathologies in a single high volume aortic centre between 2012 and 2022. Anatomical ascending aorta and aortic arch parameters were analysed on a flow centreline on a dedicated 3D workstation. Sex related differences of the ascending aorta, aortic arch, and supra-aortic vessels were evaluated. Subsequently, four endovascular devices were assessed for feasibility: double and triple branched devices both for the Zenith (Cook Medical) and Relay (Terumo Aortic) platforms, first in accordance with the instructions for use and then considering the possibility of adjunctive cervical debranching. The primary endpoints were sex specific differences in aortic anatomy, while secondary endpoints included sex based feasibility of branched endograft devices.
During the study period, 395 patients underwent total aortic arch repair, of whom 152 (51 female, 33.5%) had high quality computed tomography angiograms available and were included in the study. Female patients had a shorter proximal landing zone than males (22 mm vs. 47 mm; p < .001). Left subclavian artery dissection was more frequent in men (24.8% vs. 3.9%; p < .001). Other anatomical parameters showed a similar distribution between sexes. Female patients presented a lower feasibility for double branched devices (35.3% vs. 58.4%; p = .015) as well as a tendency for lower feasibility rates for triple branched devices (31.4% vs. 47.5%; p = .081).
Although most ascending aortic and arch parameters showed similar trends in both sexes, the availability of a suitable proximal landing zone was lower in female patients. Consequently, female patients had lower feasibility rates for double arch branched endografts and, to lesser extent, for triple arch branched endografts.
评估基础近端主动脉疾病患者升主动脉和弓部解剖结构的性别差异，并评估其对使用定制、分支弓部装置进行全腔内修复的可行性的影响。
这是一项对 2012 年至 2022 年期间在一家高容量主动脉中心因远端升主动脉和/或主动脉弓病变而行开放和/或全腔内弓部修复的所有患者进行的回顾性横断面研究。在专用的 3D 工作站上，根据血流中心线分析升主动脉、主动脉弓和主动脉上部血管的解剖学参数。评估了升主动脉、主动脉弓和主动脉上部血管的性别差异。随后，评估了四种腔内装置的可行性：适用于 Zenith（库克医疗）和 Relay（泰尔茂主动脉）平台的双分支和三分支装置，首先按照使用说明进行评估，然后考虑附加颈侧支去分支的可能性。主要终点是主动脉解剖的性别特异性差异，次要终点包括分支腔内移植物装置的性别可行性。
在研究期间，395 例患者接受了全主动脉弓修复，其中 152 例（51 例女性，33.5%）有高质量的 CT 血管造影可供使用并纳入研究。女性患者近端着陆区比男性短（22mm 比 47mm；p<0.001）。男性左锁骨下动脉夹层更为常见（24.8%比 3.9%；p<0.001）。其他解剖参数在性别之间有相似的分布。女性患者双分支装置的可行性较低（35.3%比 58.4%；p=0.015），三分支装置的可行性也有降低的趋势（31.4%比 47.5%；p=0.081）。
尽管大多数升主动脉和弓部参数在两性中表现出相似的趋势，但女性患者适合的近端着陆区可用性较低。因此，女性患者双分支弓部腔内移植物的可行性较低，三分支弓部腔内移植物的可行性也较低。
