De Masi Mariangela, Guivier-Curien Carine, Gaudry Marine, Jacquier Alexis, Piquet Philippe, Deplano Valérie
Timone Aortic Center, Department of Vascular Surgery, Assistance Publique-Hôpitaux de Marseille, Timone Hospital, 13005 Marseille, France.
CNRS, Centrale Marseille, Institut de Recherche sur les Phénomènes Hors Equilibre, Aix Marseille University, 13013 Marseille, France.
J Pers Med. 2025 Aug 21;15(8):393. doi: 10.3390/jpm15080393.
: Long-term follow-up after endovascular aortic repair (TEVAR) is crucial to detect adverse aortic remodeling, even with modern stent grafts offering enhanced flexibility and durability. Conventional imaging, based on diameter measurements, may fail to identify complications such as endograft migration. : We conducted a longitudinal 3D geometric analysis of thoracic aortic and stent-graft evolution over 10 years in a patient treated for descending thoracic aortic aneurysm (DTAA) by endovascular treatment. A three-dimensional morphological analysis (length, tortuosity, angulation, and diameter) was carried out using advanced imaging software (EndoSize, MATLAB) to track aortic geometry and stent-graft behavior over time. A focused review of the literature on stent-graft migration, its risk factors, complications, and surveillance strategies was also performed. : This case illustrates how progressive geometric remodeling-including aortic elongation and increased tortuosity-can lead to delayed stent-graft migration and late type III endoleaks, with an elevated risk of rupture. The 3D analysis revealed early morphological changes that were undetectable using standard diameter-based follow-up. These observations are consistent with published data showing higher migration rates over time, particularly in tortuous anatomies. The literature review further emphasizes the clinical relevance of geometric surveillance, given the high rates of reintervention, morbidity, and mortality associated with stent-graft migration. : This study underlines the importance of personalized and geometry-based surveillance after TEVAR. Advanced morphological assessment tools provide valuable insights for the early detection of complications and tailored patient management. Their integration into routine follow-up could help optimize long-term outcomes and prevent life-threatening events such as rupture.
即使现代支架型人工血管具有更高的柔韧性和耐用性，血管腔内主动脉修复术（TEVAR）后的长期随访对于检测主动脉不良重塑仍至关重要。基于直径测量的传统成像可能无法识别诸如人工血管移位等并发症。
我们对一名接受降主动脉瘤（DTAA）血管腔内治疗的患者进行了为期10年的胸主动脉和支架型人工血管演变的纵向三维几何分析。使用先进的成像软件（EndoSize，MATLAB）进行三维形态分析（长度、迂曲度、角度和直径），以跟踪主动脉几何形状和支架型人工血管随时间的变化。我们还对关于支架型人工血管移位及其危险因素、并发症和监测策略的文献进行了重点综述。
该病例说明了渐进性几何重塑——包括主动脉伸长和迂曲度增加——如何导致支架型人工血管移位延迟和III型内漏晚期发生，并伴有破裂风险升高。三维分析揭示了使用基于标准直径的随访无法检测到的早期形态学变化。这些观察结果与已发表的数据一致，这些数据显示随着时间推移移位率更高，尤其是在解剖结构迂曲的情况下。鉴于与支架型人工血管移位相关的再次干预、发病率和死亡率较高，文献综述进一步强调了几何监测的临床相关性。
本研究强调了TEVAR后个性化和基于几何形状的监测的重要性。先进的形态学评估工具为并发症的早期检测和个性化患者管理提供了有价值的见解。将它们整合到常规随访中有助于优化长期结果并预防诸如破裂等危及生命的事件。
