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Casciaro ME, Craiem D, El Batti S, Alsac JM. Long-Term Volumetric Evaluation of Stent-Assisted Balloon-Induced Intimal Disruption and Relamination of Aortic Dissection (STABILISE) in Acute Type B Aortic Dissection. Ann Vasc Surg 2024:S0890-5096(24)00498-9. [PMID: 39098727 DOI: 10.1016/j.avsg.2024.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/26/2024] [Accepted: 07/07/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND To quantify the volumetric aortic remodeling of patients with acute type B aortic dissection treated with the stent-assisted balloon-induced intimal disruption and relamination (STABILISE) technique. METHODS All patients with acute type B aortic dissection operated with the STABILISE technique between 2014 and 2017 with preoperative, postoperative, and >12 months (follow-up) computed tomography scans were included in this study. True lumen and total aortic volume were accurately assessed in the thoracic and abdominal portions with a semiautomatic three-dimensional tool. Associations with long-term adverse events were estimated. RESULTS Seventeen patients were measured at preoperative, postoperative, and a mean follow-up of 19 ± 8 months. The false lumen to total volume ratio decreased on average from 63% to 18% after STABILISE (P < 0.001) and remained around 12% at follow-up. These remodeling was more pronounced in the thoracic aorta (7%) than in the abdominal aorta (28%). The trend in aortic size growth was stronger for volumes than for maximum areas or diameters (P < 0.001, P < 0.05, and P < 0.05, respectively). Adverse events were identified in 4 patients during a long-term follow-up of 76 ± 18 months. The only aortic size variable assessed preoperatively that was associated with undesirable events was the total volume of the abdominal aorta (P < 0.05). CONCLUSIONS A volumetric analysis of dissected aortic size after the STABILISE procedure allowed accurate quantification of mid-term aortic remodeling and helped to identify the abdominal aortic volume as a preoperative variable associated with undesirable long-term events.
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Affiliation(s)
- Mariano Ezequiel Casciaro
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTyB), Universidad Favaloro - CONICET, Buenos Aires, Argentina.
| | - Damian Craiem
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTyB), Universidad Favaloro - CONICET, Buenos Aires, Argentina; Université Paris Cité, Paris, France
| | - Salma El Batti
- Université Paris Cité, Paris, France; Department of Vascular and Endovascular Surgery, Georges Pompidou European Hospital, Paris, France
| | - Jean-Marc Alsac
- Université Paris Cité, Paris, France; Department of Vascular and Endovascular Surgery, Georges Pompidou European Hospital, Paris, France
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Ben Abdallah I, Craiem D, Casciaro M, Deza D, Ronot M, Corcos O, Castier Y, El Batti S. Case–Control Study of 3D Morphology in Isolated Mesenteric Artery Dissection. Cardiovasc Eng Technol 2022; 14:230-238. [PMID: 36471224 DOI: 10.1007/s13239-022-00649-9] [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: 05/14/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Isolated mesenteric artery dissection (IMAD) is uncommon and has not been investigated in detail. This study aimed to accurately identify the morphological differences of IMAD patients with control individuals using a detailed 3D volumetric analysis. METHODS In this retrospective case-control study, cases were patients with acute symptomatic IMAD treated in a French intestinal stroke center between January 2016 and November 2019. Case-control matching was (1:3) by age, gender, and body mass index (BMI). The semi-automatic morphological analysis of the mesenteric artery included volumetric measurements of the true and false lumen size, the centerline curvature and the 3D aortomesenteric angles. RESULTS Seventeen IMAD cases (mean age 56 ± 4 years, 94% men) were matched with 51 controls. The mean overall lumen (OL) volume was higher in IMAD patients as compared to controls (+ 64%, p < 0.001). In the same way, the mean OL cross-sectional area and diameters were higher in IMAD patients: + 77% for OL area (< 0.001) and + 34% for OL diameters (< 0.001). Meanwhile, no significant difference was found in terms of true lumen (TL) volume (p = 0.16) or cross-sectional area (p = 0.30) between IMAD patients and controls, whereas the mean TL diameter was lower in the IMAD group (p < 0.05). Patients with acute mesenteric ischemia had a lower [TL/OL volume] ratio (45% vs. 59%, p < 0.05) and longer dissections (63 mm vs. 48 mm, p < 0.01). The 3D aortomesenteric angle was significantly higher in IMAD patients at both 2 cm (p < 0.01) and 4 cm (p < 0.05) from the ostium. CONCLUSION Using an original 3D semi-automated analysis, this study shows that IMAD induces significant morphological changes compared to control individuals: a larger aortomesenteric 3D angle, an increased overall volume and area. IMAD patients with acute mesenteric ischemia presented with a more severe morphological profile.
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Menges AL, Trenner M, Radu O, Beddoe D, Kallmayer M, Zimmermann A, Eckstein HH. Lack of durability after transarterial ethylene-vinyl alcohol copolymer-embolization of type II endoleak following endovascular abdominal aortic aneurysm repair. VASA 2020; 49:483-491. [PMID: 33103625 DOI: 10.1024/0301-1526/a000905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Type II endoleak (T2EL) after endovascular aortic repair is associated with AAA sac enlargements in up to 25%, reduction of attachment zones and rarely with aortic rupture. Indications for therapy and efficacy of interventions of T2EL are not clearly established. Transarterial embolization with application of ethylene-vinyl alcohol copolymer has been described with varying outcomes. Aim of this study is to evaluate durability of OnyxTM embolization (OE) in T2EL in a consecutive series at a single tertiary vascular center. Patients and methods: Demographic data, technical success, pre- and postoperative aneurysm growth, morbidity, mortality and reintervention rates during hospital stay as well as in follow up were recorded in patients treated with OE for T2EL between 01/2015 and 12/2017. The primary endpoint was defined as persistence or reoccurrence of T2EL (durability of OE). Results: In total 15 patients (78 ± 6 years, 13 men) were treated with OE because of sac enlargement (average growth of 12 ± 8%, n = 12), persistent bleeding after AAA rupture (n = 2) or persistent T2EL with stable but large aneurysm diameter (n = 1). Mean length of stay was 8 ± 11 days. Technical success was 93.3% (n = 14). Inhospital-morbidity was 26.7%, in-hospital- and 1-year-mortality rate were 6.6% (n = 1) and 20.0% (n = 3). T2EL persisted in 20.0% (n = 3) despite of OE. Re-EL-II occurred after 40 (30-114) days in 33.3% (n = 5). Reintervention rate was 13.3% (n = 2, at day 48 and 319). Altogether clinical success with stable aneurysm diameter was achieved in 80.0% (n = 12), but durable elimination of EL was only achieved in 46.7% of patients (n = 7). Conclusions: OE is technically possible in more than 90% of patients but might be associated with severe complications. Durability of this treatment is low, since T2EL persist or reoccur in more than 50% of all patients. OE of T2EL should be reserved for few selected cases.
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Affiliation(s)
- Anna-Leonie Menges
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Trenner
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Oksana Radu
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daisy Beddoe
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Zimmermann
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
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Yafawi A, McWilliams RG, Fisher RK, England A, Karouki M, Uhanowita Marage R, Torella F. Aneurysm Growth After Endovascular Sealing of Abdominal Aortic Aneurysms (EVAS) with the Nellix Endoprosthesis. Eur J Vasc Endovasc Surg 2020; 60:671-676. [PMID: 32807677 DOI: 10.1016/j.ejvs.2020.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/17/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to measure the incidence of post endovascular aneurysm sealing (EVAS) abdominal aortic aneurysm (AAA) growth, and its association with stent migration, in a cohort of patients with differing compliance to old and new Instructions For Use (IFU). METHODS A retrospective single centre study was conducted to review the computed tomography (CT) and clinical data of elective, infrarenal EVAS cases, performed as a primary intervention, between December 2013 and March 2018. All included patients had a baseline post-operative CT scan at one month and at least one year follow up. The primary outcome measure was the incidence of AAA growth and its association with stent migration. AAA growth was defined as a ≥5% increase in aortic volume between the lowermost renal artery and the aortic bifurcation post EVAS at any time during follow up, in comparison to the baseline CT scan. Migration was defined according to the ESVS guidelines, as > 10 mm downward movement of either Nellix stent frame in the proximal zone. RESULTS Seventy-six patients were eligible for inclusion in the study (mean age 76 ± 7.4 years; 58 men). AAA growth was identified in 50 of 76 patients (66%); adherence to IFU did not affect its incidence (mean growth within IFU-2016 compliant cohort vs. non-compliant: 16% vs. 13%, p = .33). Over time, the incidence of AAA growth increased, from 32% at one year to 100% at four years. AAA growth by volume was progressive (p < .001), as its extent increased over time. Migration was detected in 16 patients and there was a statistically significant association with AAA growth (13 patients displayed migration and AAA growth, p = .036). CONCLUSION Patients treated with EVAS are prone to AAA growth, irrespective of whether their aortic anatomy is IFU compliant. AAA growth by volume is associated with stent migration. Clinicians should continue close surveillance post EVAS, regardless of whether patients are treated within IFU.
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Affiliation(s)
- Asma Yafawi
- Institute of Translational Medicine, University of Liverpool, UK.
| | - Richard G McWilliams
- Institute of Translational Medicine, University of Liverpool, UK; Department of Radiology, Royal Liverpool & Broadgreen University Hospital, UK; School of Physical Sciences, University of Liverpool, UK; Liverpool Cardiovascular Service, Liverpool, UK
| | - Robert K Fisher
- Liverpool Cardiovascular Service, Liverpool, UK; Liverpool Vascular & Endovascular Service, Liverpool, UK; School of Engineering, University of Liverpool, UK
| | | | - Maria Karouki
- Liverpool Vascular & Endovascular Service, Liverpool, UK
| | | | - Francesco Torella
- Institute of Translational Medicine, University of Liverpool, UK; School of Physical Sciences, University of Liverpool, UK; Liverpool Cardiovascular Service, Liverpool, UK; Liverpool Vascular & Endovascular Service, Liverpool, UK; Institute of Medicine, University of Chester, UK
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Dottori J, Casciaro M, Craiem D, El-Batti S, Mousseaux E, Alsac JM, Larrabide I. Regional assessment of vascular morphology and hemodynamics: methodology and evaluation for abdominal aortic aneurysms after endovascular repair. Comput Methods Biomech Biomed Engin 2020; 23:1060-1070. [DOI: 10.1080/10255842.2020.1786073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Javier Dottori
- Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
| | - Mariano Casciaro
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro - CONICET, Buenos Aires, Argentina
| | - Damian Craiem
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB), Universidad Favaloro - CONICET, Buenos Aires, Argentina
| | | | | | | | - Ignacio Larrabide
- Pladema - CONICET, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
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Hertault A. Too Big or Not Too Big…? Eur J Vasc Endovasc Surg 2020; 60:677. [PMID: 32386791 DOI: 10.1016/j.ejvs.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/26/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Adrien Hertault
- Vascular and Endovascular Surgery Department, Valenciennes General Hospital, 114 Avenue Desandrouin, 59300, Valenciennes, France.
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