Top

Published in:

01-05-2015 | Original Article

Aortic morphometry at endograft position as assessed by 3D image analysis affects risk of type I endoleak formation after TEVAR

Authors: Drosos Kotelis, Carolin Brenke, Stefan Wörz, Fabian Rengier, Karl Rohr, Hans-Ulrich Kauczor, Dittmar Böckler, Hendrik von Tengg-Kobligk

Published in: Langenbeck's Archives of Surgery | Issue 4/2015

Abstract

Purpose

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).

Methods

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).

Results

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).

Conclusions

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.

Patel HJ, Williams DM, Upchurch GR Jr, Shillingford MS, Dasika NL, Proctor MC, Deeb GM (2006) Long-term results from a 12-year experience with endovascular therapy for thoracic aortic disease. Ann Thorac Surg 82:2147–2153CrossRefPubMed

Glade GJ, Vahl AC, Wisselink W, Linsen MA, Balm R (2005) Mid-term survival and costs of treatment of patients with descending thoracic aortic aneurysms; endovascular vs. open repair: a case-control study. Eur J Vasc Endovasc Surg 29:28–34CrossRefPubMed

Stone DH, Brewster DC, Kwolek CJ, Lamuraglia GM, Conrad MF, Chung TK, Cambria RP (2006) Stent-graft versus open-surgical repair of the thoracic aorta: mid-term results. J Vasc Surg 44:1188–1197CrossRefPubMed

Geisbüsch P, Hoffmann S, Kotelis D, Able T, Hyhlik-Dürr A, Böckler D (2011) Reinterventions during midterm follow-up after endovascular treatment of thoracic aortic disease. J Vasc Surg 53:1528–33CrossRefPubMed

Ueda T, Fleischmann D, Dake MD, Rubin GD, Sze DY (2010) Incomplete endograft apposition to the aortic arch: bird-beak configuration increases risk of endoleak formation after thoracic endovascular aortic repair. Radiology 255:645–652CrossRefPubMed

Sze DY, van den Bosch MA, Dake MD, Miller DC, Hofmann LV, Varghese R, Malaisrie SC, van der Starre PJ, Rosenberg J, Mitchell RS (2009) Factors portending endoleak formation after thoracic aortic stent-graft repair of complicated aortic dissection. Circ Cardiovasc Interv 2:105–12CrossRefPubMed

Morales JP, Greenberg RK, Lu Q, Cury M, Hernandez AV, Mohabbat W, Moon MC, Morales CA, Bathurst S, Schoenhagen P (2008) Endoleaks following endovascular repair of thoracic aortic aneurysm: etiology and outcomes. J Endovasc Ther 15:631–8CrossRefPubMed

Fillinger MF, Greenberg RK, McKinsey JF, Elliot L, Chaikof EL (2010) Reporting standards for thoracic endovascular aortic repair (TEVAR). J Vasc Surg 52:1022–33CrossRefPubMed

Kotelis D, Geisbüsch P, Hinz U, Hyhlik-Dürr A, von Tengg-Kobligk H, Allenberg JR, Böckler D (2009) Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aorta. J Vasc Surg 50:1285–92CrossRefPubMed

10.

Lee WA (2007) Endovascular abdominal aortic aneurysm sizing and case planning using the TeraRecon Aquarius workstation. Vasc Endovascular Surg 41:61–67CrossRefPubMed

11.

Wörz S, Rohr K (2007) Segmentation and quantification of human vessels using a 3-D cylindrical intensity model. IEEE Trans Image Process 16:1994–2004CrossRefPubMed

12.

Wörz S, von Tengg-Kobligk H, Henninger V, Rengier F, Schumacher H, Böckler D, Kauczor HU, Rohr K (2010) 3-D quantification of the aortic arch morphology in 3-D CTA data for endovascular aortic repair. IEEE Trans Biomed Eng 57:2359–2368CrossRefPubMed

13.

White GH, Yu W, May J, Chaufour X, Stephen MS (1997) Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. J Endovasc Surg 4:152–68CrossRefPubMed

14.

Ueda T, Takaoka H, Raman B, Rosenberg J, Rubin GD (2011) Impact of quantitatively determined native thoracic aortic tortuosity on endoleak development after thoracic endovascular aortic repair. AJR Am J Roentgenol 197:1140–6CrossRef

15.

Nakatamari H, Ueda T, Ishioka F, Raman B, Kurihara K, Rubin GD, Ito H, Sze DY (2011) Discriminant analysis of native thoracic aortic curvature: risk prediction for endoleak formation after thoracic endovascular aortic repair. J Vasc Interv Radiol 22:974–979CrossRefPubMed

16.

Alberta HB, Secor JL, Smits TC, Farber MA, Jordan WD, Matsumura JS (2013) Differences in aortic arch radius of curvature, neck size, and taper in patients with traumatic and aortic disease. J Surg Res 184:613–8CrossRefPubMed

17.

Farber MA, Giglia JS, Starnes BW, Stevens SL, Holleman J, Chaer R, Matsumura JS (2013) Evaluation of the redesigned conformable GORE TAG thoracic endoprosthesis for traumatic aortic transection. J Vasc Surg 58:651–8CrossRefPubMed

18.

Hsu HL, Chen CK, Chen PL, Chen IM, Hsu CP, Chen CW, Shih CC (2014) The impact of bird-beak configuration on aortic remodeling of distal arch pathology after thoracic endovascular aortic repair with the Zenith Pro-Form TX2 thoracic endograft. J Vasc Surg 59:80–8CrossRefPubMed

19.

Geisbüsch P, Kotelis D, Hyhlik-Dürr A, Hakimi M, Attigah N, Böckler D (2010) Endografting in the aortic arch—does the proximal landing zone influence outcome? Eur J Vasc Endovasc Surg 39:693–699CrossRefPubMed

20.

Kotelis D, Lopez-Benitez R, von Tengg-Kobligk H, Geisbüsch P, Böckler D (2008) Endovascular repair of stent graft collapse by stent-protected angioplasty using a femoral-brachial guidewire. J Vasc Surg 48:1609–12CrossRefPubMed

Title: Aortic morphometry at endograft position as assessed by 3D image analysis affects risk of type I endoleak formation after TEVAR
Authors: Drosos Kotelis
Carolin Brenke
Stefan Wörz
Fabian Rengier
Karl Rohr
Hans-Ulrich Kauczor
Dittmar Böckler
Hendrik von Tengg-Kobligk
Publication date: 01-05-2015
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 4/2015
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-015-1291-1

At a glance: The STEP trials

Springer Medicine

Aortic morphometry at endograft position as assessed by 3D image analysis affects risk of type I endoleak formation after TEVAR

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2015

Significant reduction in the incidence of small bowel obstruction and ventral hernia after laparoscopic compared to open segmental colorectal resection

Optimal indication of neoadjuvant chemoradiotherapy for pancreatic cancer

Mortality after thyroid surgery, insignificant or still an issue?

Incidence and risk factors for symptomatic venous thromboembolism following cholecystectomy

Surgical management of acute cholecystitis

Laparoscopic cholecystectomy: consensus conference-based guidelines