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Fan YN, Ke X, Yi ZL, Lin YQ, Deng BQ, Shu XR, Yang DH, Liao ZY, Nie RQ. Plasma D-dimer as a predictor of intraluminal thrombus burden and progression of abdominal aortic aneurysm. Life Sci 2020; 240:117069. [PMID: 31751582 DOI: 10.1016/j.lfs.2019.117069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/03/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
AIM Intraluminal thrombus (ILT) is presented in most abdominal aortic aneurysms (AAAs) and is suggested to promote AAA expansion. D-dimer, a breakdown product in the thrombus remodeling, may have prognostic value for AAA. This study investigated the interrelation between plasma D-dimer level, ILT volume, AAA size and progression. MAIN METHODS This was a retrospective observational study that involved 181 patients with infra-renal AAA. They were divided into small and large AAA groups according to AAA diameter. 24 of them had repeated abdominal computed tomography angiography (CTA) scan and were divided into slow-growing and fast-growing AAA groups according to the median value of AAA growth rate. Baseline and follow-up plasma D-dimer level, maximum diameter of AAA, total infra-renal aortic volume and ILT volume were analyzed. KEY FINDINGS Plasma D-dimer level was positively correlated with ILT volume (R = 0.382, P < 0.001) and maximum diameter of AAA (R = 0.442, P < 0.001). Increasing value of plasma D-dimer was positively associated with the accelerated growth rate of AAA (R = 0.720, P < 0.01). ILT volume showed positive correlation with maximum diameter (R = 0.859, P < 0.001) and growth rate of AAA (R = 0.490, P < 0.05). After adjusting the baseline ILT volume, the positive correlations remained to be statistically significant between plasma D-dimer level and AAA size (R = 0.200, P < 0.05), as well as increasing value of plasma D-dimer and growth rate of AAA (R = 0.642, P < 0.05). SIGNIFICANCE Plasma D-dimer level reflected ILT burden in AAAs. Plasma D-dimer level and ILT volume were positively correlated with AAA size. Increasing value of plasma D-dimer and baseline ILT volume could be predictors of AAA progression.
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Affiliation(s)
- Ying-Nan Fan
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Xiao Ke
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen (Sun Yat-sen Cardiovascular Hospital, Shenzhen), No. 12, Langshan Road, Nanshan District, Shenzhen 518057, China.
| | - Zhi-Long Yi
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Yong-Qing Lin
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Bing-Qing Deng
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Xiao-Rong Shu
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
| | - Da-Hao Yang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen (Sun Yat-sen Cardiovascular Hospital, Shenzhen), No. 12, Langshan Road, Nanshan District, Shenzhen 518057, China.
| | - Zhi-Yong Liao
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen (Sun Yat-sen Cardiovascular Hospital, Shenzhen), No. 12, Langshan Road, Nanshan District, Shenzhen 518057, China.
| | - Ru-Qiong Nie
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Yuexiu District, Guangzhou 510120, China.
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2
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Koenrades MA, Bosscher MRF, Ubbink JT, Slump CH, Geelkerken RH. Geometric Remodeling of the Perirenal Aortic Neck at and Adjacent to the Double Sealing Ring of the Anaconda Stent-Graft After Endovascular Aneurysm Repair. J Endovasc Ther 2019; 26:855-864. [PMID: 31736427 PMCID: PMC6864107 DOI: 10.1177/1526602819882379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Purpose: To evaluate if the radial force of the double sealing ring
of the Anaconda stent-graft induces dilatation in the perirenal aortic neck
adjacent to the rings. Materials and Methods: This study evaluated
the serial electrocardiogram-gated computed tomography scans of 15 abdominal
aortic aneurysm patients (mean age 72.8±3.7 years; 14 men) who were treated
electively using an Anaconda stent-graft. Follow-up scans were conducted before
discharge and at 1, 6, 12, and 24 months after endovascular repair. Diameter and
area were assessed perpendicular to the aortic centerline along the perirenal
aortic neck, which was subdivided into 3 zones: the suprastent, the stent, and
the infrastent zones. Measurements were performed independently by 2 experienced
observers using dedicated 3-dimensional image processing software.
Results: Between discharge and the 2-year follow-up the
diameter and area remained stable in the suprastent zone [average diameter
change: −0.1±0.4 mm (−0.4%±1.7%), p=0.893; average area change: −2.9±17.2
mm2 (−0.7%±3.4%), p=0.946], increased in the stent zone [average
diameter change: +1.9±1.0 mm (+7.3%±4.0%), p<0.001; average area change:
+84.3±48.3 mm2 (+15.5%±8.7%), p<0.001], and diverged in the
infrastent zone [average diameter change: −0.8±2.2 mm (−2.3%±7.4%), p>0.99;
average area change: −34.6±102.3 mm2 (−4.1%±14.8%), p>0.99;
increased in 4 patients, decreased in 9 patients]. Conclusion:
After Anaconda implantation the infrarenal aortic neck accommodated to the
expansion of the sealing rings at the stent zone. Below the stent zone the neck
diameter decreased in the majority of patients, while an increase was related to
downstream displacement of the main body. A decrease in size in the infrastent
zone may contribute to durable sealing and fixation. A personalized follow-up
scheme based on geometric neck remodeling should be feasible if our observations
are confirmed in larger, long-term studies.
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Affiliation(s)
- Maaike A Koenrades
- Multi-modality Medical Imaging (M3I) group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands.,Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.,Robotics and Mechatronics (RaM) group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | | | - Jouke T Ubbink
- Technical Medicine, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics (RaM) group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Robert H Geelkerken
- Multi-modality Medical Imaging (M3I) group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands.,Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
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3
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Schuurmann RC, De Rooy PM, Bastos Gonçalves F, Vos CG, De Vries JPP. A systematic review of standardized methods for assessment of endograft sealing on computed tomography angiography post-endovascular aortic repair, and its influence on endograft-associated complications. Expert Rev Med Devices 2019; 16:683-695. [DOI: 10.1080/17434440.2019.1644165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Richte C.L. Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Philippe M. De Rooy
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Frederico Bastos Gonçalves
- Department of Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Cornelis G. Vos
- Department of Vascular Surgery, Martini Hospital Groningen, Groningen, The Netherlands
| | - Jean-Paul P.M. De Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Centre Groningen, Groningen, The Netherlands
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4
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Schuurmann RCL, Overeem SP, van Noort K, de Vries BA, Slump CH, de Vries JPPM. Validation of a New Methodology to Determine 3-Dimensional Endograft Apposition, Position, and Expansion in the Aortic Neck After Endovascular Aneurysm Repair. J Endovasc Ther 2018; 25:358-365. [DOI: 10.1177/1526602818764413] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose: To validate a novel methodology employing regular postoperative computed tomography angiography (CTA) scans to assess essential factors contributing to durable endovascular aneurysm repair (EVAR), including endograft deployment accuracy, neck adaptation to radial forces, and effective apposition of the fabric within the aortic neck. Methods: Semiautomatic calculation of the apposition surface between the endograft and the infrarenal aortic neck was validated in vitro by comparing the calculated surfaces over a cylindrical silicon model with known dimensions on CTA reconstructions with various slice thicknesses. Interobserver variabilities were assessed for calculating endograft position, apposition, and expansion in a retrospective series of 24 elective EVAR patients using the repeatability coefficient (RC) and the intraclass correlation coefficient (ICC). The variability of these calculations was compared with variability of neck length and diameter measurements on centerline reconstructions of the preoperative and first postoperative CTA scans. Results: In vitro validation showed accurate calculation of apposition, with deviation of 2.8% from the true surface for scans with 1-mm slice thickness. Excellent agreement was achieved for calculation of the endograft dimensions (ICC 0.909 to 0.996). Variability was low for calculation of endograft diameter (RC 2.3 mm), fabric distances (RC 5.2 to 5.7 mm), and shortest apposition length (RC 4.1 mm), which was the same as variability of regular neck diameter (RC 0.9 to 1.1 mm) and length (RC 4.0 to 8.0 mm) measurements. Conclusion: This retrospective validation study showed that apposition surfaces between an endograft and the infrarenal neck can be calculated accurately and with low variability. Determination of the (ap)position of the endograft in the aortic neck and detection of subtle changes during follow-up are crucial to determining eventual failure after EVAR.
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Affiliation(s)
- Richte C. L. Schuurmann
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - Simon P. Overeem
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - Kim van Noort
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - Bastiaan A. de Vries
- Technical Medicine, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - Cornelis H. Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
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5
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Velu JF, Groot Jebbink E, de Vries JPP, van der Palen JA, Slump CH, Geelkerken RH. A phantom study for the comparison of different brands of computed tomography scanners and software packages for endovascular aneurysm repair sizing and planning. Vascular 2017; 26:198-202. [PMID: 28820356 DOI: 10.1177/1708538117726648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Correct sizing of endoprostheses used for the treatment of abdominal aortic aneurysms is important to prevent endoleaks and migration. Sizing requires several steps and each step introduces a possible sizing error. The goal of this study was to investigate the magnitude of these errors compared to the golden standard: a vessel phantom. This study focuses on the errors in sizing with three different brands of computed tomography angiography scanners in combination with three reconstruction software packages. Methods Three phantoms with a different diameter, altitude and azimuth were scanned with three computed tomography scanners: Toshiba Aquilion 64-slice, Philips Brilliance iCT 256-slice and Siemens Somatom Sensation 64-slice. The phantom diameters were determined in the stretched view after central lumen line reconstruction by three observers using Simbionix PROcedure Rehearsal Studio, 3mensio and TeraRecon planning software. The observers, all novices in sizing endoprostheses using planning software, measured 108 slices each. Two senior vascular surgeons set the tolerated error margin of sizing on ±1.0 mm. Results In total, 11.3% of the measurements (73/648) were outside the set margins of ±1.0 mm from the phantom diameter, with significant differences between the scanner types (14.8%, 12.1%, 6.9% for the Siemens scanner, Philips scanner and Toshiba scanner, respectively, p-value = 0.032), but not between the software packages (8.3%, 11.1%, 14.4%, p-value = 0.141) or the observers (10.6%, 9.7%, 13.4%, p-value = 0.448). Conclusions It can be concluded that the errors in sizing were independent of the used software packages, but the phantoms scanned with Siemens scanner were significantly more measured incorrectly than the phantoms scanned with the Toshiba scanner. Consequently, awareness on the type of computed tomography scanner and computed tomography scanner setting is necessary, especially in complex abdominal aortic aneurysms sizing for fenestrated or branched endovascular aneurysm repair if appropriate the sizing is of upmost importance.
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Affiliation(s)
- Juliëtte F Velu
- Department of Vascular Surgery, Medical Spectrum Twente, Enschede, the Netherlands.,MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Erik Groot Jebbink
- MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, the Netherlands
| | | | - Job Am van der Palen
- Medical School Twente, Medical Spectrum Twente, Enschede, the Netherlands.,5 Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, the Netherlands
| | - Cornelis H Slump
- MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medical Spectrum Twente, Enschede, the Netherlands.,Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
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6
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Hoegen P, Wörz S, Müller-Eschner M, Geisbüsch P, Liao W, Rohr K, Schmitt M, Rengier F, Kauczor HU, von Tengg-Kobligk H. How Precise Are Preinterventional Measurements Using Centerline Analysis Applications? Objective Ground Truth Evaluation Reveals Software-Specific Centerline Characteristics. J Endovasc Ther 2017; 24:584-594. [PMID: 28587563 DOI: 10.1177/1526602817713737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate different centerline analysis applications using objective ground truth from realistic aortic aneurysm phantoms with precisely defined geometry and centerlines to overcome the lack of unknown true dimensions in previously published in vivo validation studies. METHODS Three aortic phantoms were created using computer-aided design (CAD) software and a 3-dimensional (3D) printer. Computed tomography angiograms (CTAs) of phantoms and 3 patients were analyzed with 3 clinically approved and 1 research software application. The 3D centerline coordinates, intraluminal diameters, and lengths were validated against CAD ground truth using a dedicated evaluation software platform. RESULTS The 3D centerline position mean error ranged from 0.7±0.8 to 2.9±2.5 mm between tested applications. All applications calculated centerlines significantly different from ground truth. Diameter mean errors varied from 0.5±1.2 to 1.1±1.0 mm among 3 applications, but exceeded 8.0±11.0 mm with one application due to an unsteady distortion of luminal dimensions along the centerline. All tested commercially available software tools systematically underestimated centerline total lengths by -4.6±0.9 mm to -10.4±4.3 mm (maximum error -14.6 mm). Applications with the highest 3D centerline accuracy yielded the most precise diameter and length measurements. CONCLUSION One clinically approved application did not provide reproducible centerline-based analysis results, while another approved application showed length errors that might influence stent-graft choice and procedure success. The variety and specific characteristics of endovascular aneurysm repair planning software tools require scientific evaluation and user awareness.
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Affiliation(s)
- Philipp Hoegen
- 1 Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.,2 Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Wörz
- 3 BIOQUANT, IPMB, and DKFZ Heidelberg, Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, Germany
| | - Matthias Müller-Eschner
- 1 Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.,4 Nuclear Medicine, University Hospital Frankfurt, Germany
| | - Philipp Geisbüsch
- 5 Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | - Wei Liao
- 3 BIOQUANT, IPMB, and DKFZ Heidelberg, Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, Germany
| | - Karl Rohr
- 3 BIOQUANT, IPMB, and DKFZ Heidelberg, Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, Germany
| | - Matthias Schmitt
- 5 Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany
| | - Fabian Rengier
- 1 Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.,2 Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- 1 Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Hendrik von Tengg-Kobligk
- 1 Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany.,6 Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital, University of Bern, Switzerland.,7 Department of Radiology, Wright Center of Innovation in Biomedical Imaging, Ohio State University, Columbus, OH, USA
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7
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Hossain S, Lee K, Power AH. Reply. J Vasc Surg 2017; 65:1871-1872. [PMID: 28527940 DOI: 10.1016/j.jvs.2017.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 02/10/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Sajjid Hossain
- Division of Vascular Surgery, Western University, London, Ontario, Canada
| | - Kevin Lee
- Division of Vascular Surgery, Western University, London, Ontario, Canada
| | - Adam H Power
- Division of Vascular Surgery, Western University, London, Ontario, Canada
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8
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Predicting Mid-term All-cause Mortality in Patients Undergoing Elective Endovascular Repair of a Descending Thoracic Aortic Aneurysm. Ann Surg 2016; 264:1162-1167. [DOI: 10.1097/sla.0000000000001577] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Kaladji A, Daoudal A, Duménil A, Göksu C, Cardon A, Clochard E, Lucas A, Lalys F. Predictive Models of Complications after Endovascular Aortic Aneurysm Repair. Ann Vasc Surg 2016; 40:19-27. [PMID: 27903486 DOI: 10.1016/j.avsg.2016.08.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 06/30/2016] [Accepted: 08/04/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND The risk of long-term complications after endovascular aneurysm repair (EVAR) is still higher than open surgery and is a critical issue. This study aims to make available reliable statistical predictive models of complications after EVAR. METHODS Two hundred and thirteen patients who underwent EVAR between 2002 and 2012 were included in this study. The preoperative computed tomography scans were analyzed with a dedicated workstation to provide spatially correct 3-dimensional data. Age, gender, operation-related factors, and 21 morphologic variables were measured and included in the analyses. Five postoperative outcomes were studied. After an initial selection of predictors based on univariate analysis, binomial logistic regression models were proposed for each outcome. The ability to predict each outcome was assessed with receiver operating characteristic curves considering that an area under the curve (AUC) > 0.70 is generally considered sufficiently accurate. RESULTS The mean age was 74.8 ± 8.6 years with a mean follow-up of 43.8 ± 22.1 months. Respectively, rates and risk factors of each outcome were 25.3% (n = 51) for abdominal aortic aneurysm (AAA) enlargement (age, number of patent sac branches, iliac calcifications and tortuosity, aneurysmal thrombus), 7% (n = 15) for type IA endoleak (neck calcification and AAA diameter), 3.7% (n = 8) for type IB endoleak (iliac tortuosity, AAA diameter, neck thrombus), 19.8% (n = 40) for type II endoleak (female, number of patent sac branches), and 25.9% (n = 55) for reintervention from any cause (neck calcification). The risk associated to each outcome can be calculated with a combination of these different preoperative variables. AUC for each outcome were 79.6% for AAA enlargement, 70.4% for reintervention, 81.3% for type IA endoleak, 92.3% for type IB endoleak, 70.6% for type II endoleak. CONCLUSIONS This study shows that an exhaustive description of the preoperative anatomy before EVAR is a powerful and reliable tool to predict the risk of developing the most common complications after EVAR.
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Affiliation(s)
- Adrien Kaladji
- CHU Rennes, Department of Cardiothoracic and Vascular Surgery, Rennes, France; INSERM, U1099, Rennes, France; University Rennes 1, Signal and Image Processing Laboratory (LTSI), Rennes, France.
| | - Anne Daoudal
- CHU Rennes, Department of Cardiothoracic and Vascular Surgery, Rennes, France; INSERM, U1099, Rennes, France; University Rennes 1, Signal and Image Processing Laboratory (LTSI), Rennes, France
| | - Aurélien Duménil
- INSERM, U1099, Rennes, France; University Rennes 1, Signal and Image Processing Laboratory (LTSI), Rennes, France
| | | | - Alain Cardon
- CHU Rennes, Department of Cardiothoracic and Vascular Surgery, Rennes, France
| | - Elodie Clochard
- CHU Rennes, Department of Cardiothoracic and Vascular Surgery, Rennes, France
| | - Antoine Lucas
- CHU Rennes, Department of Cardiothoracic and Vascular Surgery, Rennes, France; INSERM, U1099, Rennes, France; University Rennes 1, Signal and Image Processing Laboratory (LTSI), Rennes, France
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10
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Rouet L, Mory B, Attia E, Bredahl K, Long A, Ardon R. A minimally interactive and reproducible method for abdominal aortic aneurysm quantification in 3D ultrasound and computed tomography with implicit template deformations. Comput Med Imaging Graph 2016; 58:75-85. [PMID: 27939282 DOI: 10.1016/j.compmedimag.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/20/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
The maximum diameter of abdominal aortic aneurysm (AAA) is a key quantification parameter for disease assessment. Although it is routinely measured on 2D-ultrasound images, using a volumetric approach is expected to improve measurement reproducibility. In this work, 3D-ultrasound or computed tomography imaging of patients with AAA was combined with a minimally interactive 3D segmentation based on implicit template deformation. Segmentation usability and reproducibility were evaluated on 81 patients, showing a mean measurement time of [2;8]min per case, and Dice coefficients of 0.87±0.12 for 3D-US and 0.81±0.08 for CT. Quantification parameters included a diameter measurement from 3D-US and CT volumes with respective confidence intervals of 0.51 [-2.5;3.52]mm and 1.00 [-1.68;3.67]mm. Additional volume measurements showed confidence intervals of 0.91 [-4.17;5.99]ml for 3D-US and 4.10 [-4.11;12.30]ml for CT.
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Affiliation(s)
- L Rouet
- Philips Research, 33 rue de Verdun, 92156 Suresnes Cedex, France.
| | - B Mory
- Philips Research, 33 rue de Verdun, 92156 Suresnes Cedex, France
| | - E Attia
- Philips Research, 33 rue de Verdun, 92156 Suresnes Cedex, France
| | - K Bredahl
- Department of Vascular Surgery, Rigshospitalet, Univ. of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - A Long
- Médecine Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Place d'Arsonval, 69437 Lyon Cedex 03, France
| | - R Ardon
- Philips Research, 33 rue de Verdun, 92156 Suresnes Cedex, France
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11
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Velu JF, Groot Jebbink E, de Vries JPPM, Slump CH, Geelkerken RH. Validation of the Simbionix PROcedure Rehearsal Studio sizing module: A comparison of software for endovascular aneurysm repair sizing and planning. Vascular 2016; 25:80-85. [DOI: 10.1177/1708538116651009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An important determinant of successful endovascular aortic aneurysm repair is proper sizing of the dimensions of the aortic-iliac vessels. The goal of the present study was to determine the concurrent validity, a method for comparison of test scores, for EVAR sizing and planning of the recently introduced Simbionix PROcedure Rehearsal Studio (PRORS). Seven vascular specialists analyzed anonymized computed tomography angiography scans of 70 patients with an infrarenal aneurysm of the abdominal aorta, using three different sizing software packages Simbionix PRORS (Simbionix USA Corp., Cleveland, OH, USA), 3mensio (Pie Medical Imaging BV, Maastricht, The Netherlands), and TeraRecon (Aquarius, Foster City, CA, USA). The following measurements were included in the protocol: diameter 1 mm below the most distal main renal artery, diameter 15 mm below the lowest renal artery, maximum aneurysm diameter, and length from the most distal renal artery to the left iliac artery bifurcation. Averaged over the locations, the intraclass correlation coefficient is 0.83 for Simbionix versus 3mensio, 0.81 for Simbionix versus TeraRecon, and 0.86 for 3mensio versus TeraRecon. It can be concluded that the Simbionix sizing software is as precise as two other validated and commercially available software packages.
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Affiliation(s)
- Juliëtte F Velu
- Department of Vascular Surgery, Medical Spectrum Twente, The Netherlands
- MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, The Netherlands
| | - Erik Groot Jebbink
- MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, The Netherlands
| | | | - Cornelis H Slump
- MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, The Netherlands
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medical Spectrum Twente, The Netherlands
- Faculty of Science and Technology, University of Twente, The Netherlands
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12
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Tam MD, Latham TR, Lewis M, Khanna K, Zaman A, Parker M, Grunwald IQ. A Pilot Study Assessing the Impact of 3-D Printed Models of Aortic Aneurysms on Management Decisions in EVAR Planning. Vasc Endovascular Surg 2016; 50:4-9. [DOI: 10.1177/1538574415623651] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Endovascular repair of aortic aneurysms with difficult anatomy is challenging. There is no consensus for planning such procedures. Methods: Six cases of aortic aneurysms with challenging anatomical features, such as short, angulated, and conical necks and tortuous iliacs were harvested. The computed tomography (CT) scans were anonymized. Lifesize 3-dimensional (3-D) printed models were created of the lumen. Endovascular operators were asked to review the CT angiography (CTA), make a management plan, and give an indication of their confidence. They were then presented with the equivalent model and asked to review their decision. Their attitudes to such models were briefly surveyed. Results: A total of 28 endovascular operators reviewed 144 cases. After review of the physical model, the management plan changed in 29 (20.1%) of 144 cases. Initial plan after CTA review was endovascular 73.6%, open repair 22.9%, and second opinion 3.5%. After model review, this became endovascular 67.4%, open repair 19.4%, and second opinion 4.8%. Although the general trend was toward more open procedures, off-label techniques reduced from 19.4% to 15.2% following model review. When the management plan did not change, level of confidence did increase in 37 (43.5%) of 85 cases. The majority of operators stated that they would find models useful for planning in some procedures. For 1 case, the change in the percentage of participants being sure in the management plan was statistically significant ( P = .031). Conclusion: The 3-D printed models may be potentially useful in planning cases with EVAR. It is a paradigm that warrants further investigation.
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Affiliation(s)
- Matthew D. Tam
- Department of Radiology, Southend University Hopsital NHS Foundation Trust, Southend, United Kingdom
| | - Tom R. Latham
- Department of Radiology, Southend University Hopsital NHS Foundation Trust, Southend, United Kingdom
| | - Mark Lewis
- Department of Radiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
| | - Kunal Khanna
- Department of Radiology, St. Bartholomew’s and the Royal London NHS Foundation Trust, London, United Kingdom
| | - Ali Zaman
- Department of Radiology, Southend University Hopsital NHS Foundation Trust, Southend, United Kingdom
| | - Mike Parker
- Neuroscience and Vascular Simulation Unit, Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Iris Q. Grunwald
- Department of Radiology, Southend University Hopsital NHS Foundation Trust, Southend, United Kingdom
- Neuroscience and Vascular Simulation Unit, Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, United Kingdom
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13
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Nomura Y, Sugimoto K, Gotake Y, Yamanaka K, Sakamoto T, Muradi A, Okada T, Yamaguchi M, Okita Y. Comparison of Volumetric and Diametric Analysis in Endovascular Repair of Descending Thoracic Aortic Aneurysm. Eur J Vasc Endovasc Surg 2015; 50:53-9. [DOI: 10.1016/j.ejvs.2015.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/26/2015] [Indexed: 11/25/2022]
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14
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Spanos K, Karathanos C, Saleptsis V, Giannoukas AD. Systematic review and meta-analysis of migration after endovascular abdominal aortic aneurysm repair. Vascular 2015; 24:323-36. [DOI: 10.1177/1708538115590065] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim To identify patients who are under higher threat for migration because of an old generation stent graft application. Methods A systematic review and meta-analysis of the literature was undertaken to identify all studies which included older generation endografts and data reporting on graft migration after EVAR. Outcome data were pooled and combined, and were calculated using fixed or random effects models. Results From 2000 to 2014, 22 retrospective studies were identified reporting on stent- graft migration after EVAR (8.6%). From those patients, 39% received re-intervention with the mean time of identification ranging from 12 to 36 months. Six of these retrospective nonrandomized studies were eligible for meta-analysis. AAA diameter (AAA diameter: 0.719 mm; 95% confidence interval [CI]: 0.00065–1.4384 mm; p = 0.00497) and neck length (neck length: 4.36 mm; 95% CI: 1.3277–7.394; p = 0.0048) were the only significant factors associated with stent- graft migration. Neck diameter and neck angulation did not have any important influence on stent-graft migration. Conclusions Patients with large AAA and short necks who were treated with older generation stent grafts such as AneurX and Talent are in higher risk for endograft migration than others. Stent- graft migration consists of an insidious and underestimated threat.
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Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Christos Karathanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vasileios Saleptsis
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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15
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Mora CE, Marcus CD, Barbe CM, Ecarnot FB, Long AL. Maximum Diameter of Native Abdominal Aortic Aneurysm Measured by Angio-Computed Tomography: Reproducibility and Lack of Consensus Impacts on Clinical Decisions. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2015; 3:47-55. [PMID: 26798757 DOI: 10.12945/j.aorta.2015.14-059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/12/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Computed tomography angiography (CTA) is the reference technique for the measurement of native maximum abdominal aortic aneurysm (AAA) diameter when surgery is being considered. However, there is a wide choice available for the methodology of maximum AAA diameter measurement on CTA, and to date, no consensus has been reached on which method is best. We analyzed clinical decisions based on these various measures of native maximum AAA diameter with CTA, then analyzed their reproducibility and identified the method of measurement yielding the highest agreement in terms of patient management. MATERIALS AND METHODS Three sets of measures in 46 native AAA were obtained, double-blind by three radiologists (J, S, V) on orthogonal planes, curved multiplanar reconstructions, and semi-automated-software, based on the AAA-lumen centerline. From each set, the clinical decision was recorded as follows: "Follow-up" (if all diameters <50 mm), "ambiguous" (if at least one diameter <50 mm AND at least one ≥50 mm) or "Surgery " (if all diameters ≥50 mm). Intra- and interobserver agreements in clinical decisions were compared using the weighted Kappa coefficient. RESULTS Clinical decisions varied according to the measurement sets used by each observer, and according to intra and interobserver (lecture#1) reproducibility. Based on the first reading of each observer, the number of AAA proposed for surgery ranged from 11 to 24 for J, 5 to 20 for S, and 15 to 23 for V. The rate of AAAs classified as "ambiguous" varied from 11% (5/46) to 37% (17/46). The semi-automated method yielded very good intraand interobserver agreements in clinical decisions in all comparisons (Kappa range 0.83-1.00). CONCLUSION The semi-automated method seems to be appropriate for native AAA maximum diameter measurement on CTA. In the absence of AAA outer-wallbased software more robust for complex AAA, clinical decisions might best be made with diameter values obtained using this technique.
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Affiliation(s)
- Caroline E Mora
- Department of Radiology, University Hospital Reims, Hôpital Robert Debré, Reims, France
| | - Claude D Marcus
- Department of Radiology, University Hospital Reims, Hôpital Robert Debré, Reims, France
| | - Coralie M Barbe
- Clinical Research Unit, University Hospital Reims, Hôpital Robert Debré, Reims, France
| | - Fiona B Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besançon, France
| | - Anne L Long
- Department of Internal Medicine and Vascular Medicine, Pavillon M, Hospices Civils de Lyon, University Hospital Edouard Herriot, Lyon, France; Faculty of Medicine and Maieutic Charles Merieux, Claude Bernard Lyon 1 University, Oullins, France
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16
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Dowson N, Boult M, Cowled P, De Loryn T, Fitridge R. Development of an Automated Measure of Iliac Artery Tortuosity that Successfully Predicts Early Graft-Related Complications Associated with Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2014; 48:153-60. [DOI: 10.1016/j.ejvs.2014.04.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
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17
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Influence of computed tomography angiography reconstruction software on anatomic measurements and endograft component selection for endovascular abdominal aortic aneurysm repair. J Vasc Surg 2014; 59:1224-31.e1-3. [DOI: 10.1016/j.jvs.2013.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/30/2013] [Accepted: 11/03/2013] [Indexed: 11/18/2022]
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18
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Abdominally Based Free Flap Planning in Breast Reconstruction with Computed Tomographic Angiography. Plast Reconstr Surg 2014; 133:483-494. [DOI: 10.1097/01.prs.0000438058.44505.d8] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Measurement of Maximum Diameter of Native Abdominal Aortic Aneurysm by Angio-CT: Reproducibility is Better with the Semi-automated Method. Eur J Vasc Endovasc Surg 2014; 47:139-50. [DOI: 10.1016/j.ejvs.2013.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 10/14/2013] [Indexed: 11/18/2022]
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20
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Semiautomatic sizing software in emergency endovascular aneurysm repair for ruptured abdominal aortic aneurysms. Cardiovasc Intervent Radiol 2013; 37:623-30. [PMID: 24174211 DOI: 10.1007/s00270-013-0757-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/01/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE In emergency endovascular repair (EVAR) of ruptured aneurysms of the aorta (rAAA), anatomical suitability must be determined. Semiautomatic three-dimensional assessment of the aortoiliac arteries has the potential to standardise measurements. This study assesses the fitness for purpose of such a semiautomatic approach for rAAA and determined interobserver agreement on suitability. MATERIALS AND METHODS Interobserver study with six trained observers (4 vascular surgeons, 2 radiologists) blindly assessing preoperative computed tomography angiography scans of 50 consecutive patients with rAAA. A central lumen line (CLL) was generated, and perpendicular diameters, length along the CLL, and EVAR suitability were determined using dedicated sizing software (3mensio; 3mensio Vascular; Bilthoven, The Netherlands). Success of generating a CLL, time of assessment, and interobserver agreement was determined. RESULTS In the majority of the patients (median 76 %, range 64-78 %), a CLL was semiautomatically generated. The median duration of CLL generation and performance measurements was 7.5 min (interquartile range 5.5-10.6). Agreement on suitability was moderate for the entire group (Fleiss' κ = 0.55, confidence interval 0.48-0.62) and ranged from moderate to good (Cohen's κ = 0.40-0.72) between observer pairs. CONCLUSION Assessing EVAR suitability of rAAA patients using dedicated sizing software is possible in the majority of patients. The measurements can be performed in a reasonable amount of time, and the agreement of suitability for EVAR in patients with rAAA is moderate. Improvements and additional research are necessary to replace the current axial measurement.
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21
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Karthikesalingam A, Holt PJ, Vidal-Diez A, Choke EC, Patterson BO, Thompson LJ, Ghatwary T, Bown MJ, Sayers RD, Thompson MM. Predicting aortic complications after endovascular aneurysm repair. Br J Surg 2013; 100:1302-11. [DOI: 10.1002/bjs.9177] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2013] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Lifelong surveillance is standard after endovascular repair of abdominal aortic aneurysm (EVAR), but remains costly, heterogeneous and poorly calibrated. This study aimed to develop and validate a scoring system for aortic complications after EVAR, informing rationalized surveillance.
Methods
Patients undergoing EVAR at two centres were studied from 2004 to 2010. Preoperative morphology was quantified using three-dimensional computed tomography according to a validated protocol, by investigators blinded to outcomes. Proportional hazards modelling was used to identify factors predicting aortic complications at the first centre, and thereby derive a risk score. Sidak tests between risk quartiles dichotomized patients to low- or high-risk groups. Aortic complications were reported by Kaplan–Meier analysis and risk groups were compared by log rank test. External validation was by comparison of aortic complications between risk groups at the second centre.
Results
Some 761 patients, with a median age of 75 (interquartile range 70–80) years, underwent EVAR. Median follow-up was 36 (range 11–94) months. Physiological variables were not associated with aortic complications. A morphological risk score incorporating maximum aneurysm diameter (P < 0·001) and largest common iliac diameter (measured 10 mm from the internal iliac origin; P = 0·004) allocated 75 per cent of patients to a low-risk group, with excellent discrimination between 5-year rates of aortic complication in low- and high-risk groups at both centres (centre 1: 12 versus 31 per cent, P < 0·001; centre 2: 12 versus 45 per cent, P = 0·002).
Conclusion
The risk score uses commonly available morphological data to stratify the rate of complications after EVAR. The proposals for rationalized surveillance could provide clinical and economic benefits.
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Affiliation(s)
- A Karthikesalingam
- Department of Outcomes Research, St George's Vascular Institute, London, UK
| | - P J Holt
- Department of Outcomes Research, St George's Vascular Institute, London, UK
| | - A Vidal-Diez
- Department of Outcomes Research, St George's Vascular Institute, London, UK
- Department of Community Health Sciences, St George's University of London, London, UK
| | - E C Choke
- Vascular Surgery Group, University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - B O Patterson
- Department of Outcomes Research, St George's Vascular Institute, London, UK
| | - L J Thompson
- Department of Outcomes Research, St George's Vascular Institute, London, UK
| | - T Ghatwary
- Department of Outcomes Research, St George's Vascular Institute, London, UK
| | - M J Bown
- Vascular Surgery Group, University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - R D Sayers
- Vascular Surgery Group, University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - M M Thompson
- Department of Outcomes Research, St George's Vascular Institute, London, UK
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22
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Bahia SS, Karthikesalingam A, Thompson MM. Abdominal aortic aneurysms: endovascular options and outcomes - proliferating therapy, but effective? Prog Cardiovasc Dis 2013; 56:19-25. [PMID: 23993235 DOI: 10.1016/j.pcad.2013.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abdominal aortic aneurysm (AAA) has a reported prevalence rate of 1.4% in the US. AAA rupture accounts for an estimated 15,000 deaths per year, rendering it the 10th leading cause of death in men over the age of 55. Endovascular repair (EVR) has proliferated in the last two decades as an increasingly popular alternative to traditional open surgery, and is now the default treatment in the majority of centres worldwide. This review article outlines the evidence supporting this stance. The development of EVR is reviewed, alongside trends in utilisation of this therapy over time. The evidence for the relative short-term and long-term outcomes of EVR and open AAA repair is discussed, and ongoing controversies surrounding the use of EVR are considered.
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Affiliation(s)
- Sandeep S Bahia
- Department of Cardiovascular Sciences, St George's Vascular Institute, London.
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23
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Stefańczyk L, Elgalal M, Papiewski A, Szubert W, Szopiński P. Infectious or noninfectious? Ruptured, thrombosed inflammatory aortic aneurysm with spondylolysis. Cardiovasc Intervent Radiol 2012; 36:839-43. [PMID: 22972586 PMCID: PMC3646157 DOI: 10.1007/s00270-012-0464-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/29/2012] [Indexed: 11/18/2022]
Abstract
Osteolysis of vertebrae due to inflammatory aortic aneurysm is rarely observed. However, it is estimated that up to 10 % of infectious aneurysms coexist with bone tissue destruction, most commonly the vertebrae. Inflammatory aneurysms with no identified infection factor, along with infiltration of adjacent muscle and in particular extensive destruction of bone tissue have rarely been described in the literature. A case of inflammatory aneurysm with posterior wall rupture and inflammatory infiltration of the iliopsoas muscle and spine, together with extensive vertebral body destruction, is presented. The aneurysm was successfully treated with endovascular aneurysm repair EVAR.
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Affiliation(s)
- Ludomir Stefańczyk
- Department of Radiology and Diagnostic Imaging, Medical University of Łódź, ul. Kopcińskiego 22, 90-159 Łódź, Poland
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