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Kakehi K, Ueno M, Kawamura T, Yamada N, Takahashi K, Fujita K, Yasuda M, Matsumura K, Miyoshi T, Mizutani K, Takase T, Sakaguchi G, Nakazawa G. Prognostic impact of early aortic volume changes at hospital discharge in patients with acute type B aortic dissection. J Cardiol 2024; 83:49-56. [PMID: 37591338 DOI: 10.1016/j.jjcc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Early prediction of aorta-related events is important for determining subsequent treatment strategies in patients with acute aortic dissection. However, most studies evaluated long-term aortic growth rates by annual assessment. The purpose of our study was to determine whether the in-hospital growth rate of aortic volume was associated with aorta-related events. METHODS We studied 116 patients with uncomplicated type B acute aortic dissection. We analyzed whether changes in aortic volume were associated with aorta-related events during a 5-year follow-up. According to the growth rate from admission to discharge, patients were divided into two groups: Increase >0 (aortic volume: n = 59, aortic diameter: n = 43) and Reduction ≤0 (aortic volume: n = 57, aortic diameter: n = 73) in maximum aortic diameter or aortic volume. The primary endpoint was the discriminative ability of the growth rate of aortic volume for aorta-related events. RESULTS According to the evaluation of aortic volume changes, the Increase group had significantly higher aorta-related event rates than those in the Reduction group (49.2 % vs. 3.5 %, respectively; p < 0.001). Receiver operating characteristics analysis showed that the growth rate of aortic volume had a clearly useful discrimination, with an area under the curve of 0.84, whereas the discriminative ability of the growth rate of maximum aortic diameter was poor (area under the curve: 0.53). Multivariate analysis showed that the growth rate of aortic volume from admission to discharge was an independent predictor of aorta-related events (hazard ratio, 26.3; 95 % confidence interval, 2.04-286.49; p = 0.001). CONCLUSIONS In-hospital evaluation of aortic volume was helpful to predict long-term aorta-related events in patients with uncomplicated type B acute aortic dissection.
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Affiliation(s)
- Kazuyoshi Kakehi
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Masafumi Ueno
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Takayuki Kawamura
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Nobuhiro Yamada
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Kuniaki Takahashi
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Kosuke Fujita
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Masakazu Yasuda
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Koichiro Matsumura
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Tatsuya Miyoshi
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Kazuki Mizutani
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Toru Takase
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Gaku Nakazawa
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan.
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Deshpande AA, Pandey NN, Shaw M, Kumar S, Jagia P, Sharma S, Choudhary S. Stent-Graft Migration Post-Endovascular Repair of Thoracic Aorta: A Retrospective Cohort Study. Indian J Radiol Imaging 2022; 32:324-331. [PMID: 36177280 PMCID: PMC9514910 DOI: 10.1055/s-0042-1754317] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Abstract
Background Migration of the stent-graft post-thoracic endovascular aortic repair (TEVAR) is not uncommon; however, it is sparsely reported. The objective of this study was to assess the incidence, risk factors, and complications of stent-graft migration post-TEVAR.
Materials and Methods Thirty-one patients who underwent TEVAR were retrospectively analyzed. The demographic, anatomical, and procedure-related factors were assessed. The measurements were done along the greater curvature of aorta around two fixed anatomic landmarks, that is, left common carotid artery or neoinnominate artery (hybrid repair) proximally and celiac artery distally. Aortic elongation and migration at proximal, distal, as well as at overlapping zone were measured. More than 10 mm of migration was considered significant.
Results Significant migration was observed in six (19%) patients. No significant migration was observed in the overlapping zone. The proximal landing zone 3 (odds ratio [OR] 12.78, p 0.01) was a significant risk factor, whereas landing zone 2 was a protective factor against the migration (OR 0.08, p 0.02). The odds for migration were more in segments I/3 and II/3 compared with I/2 and II/2, respectively, as per Modified Arch Landing Areas Nomenclature. A single complication was seen in the migration group which was treated by an overlapping stent graft.
Conclusion The stent-graft migration after TEVAR is not uncommon. Type 3 proximal landing zone was a significant risk factor for migration with an increased risk toward I/3 and II/3. Proximal landing zone 2 as well as adequate overlapping distance in multiple stent grafts can prevent migration.
Ethical Approval No IECPG-227/24.06.2020
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Affiliation(s)
- Amit Ajit Deshpande
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Shaw
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjiv Sharma
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Choudhary
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Ojha V, Ganga KP, Goyal A, Reddy PR, Kumar S, Sharma S. Greater Curvature, Centerline or Straightened Centerline Length - Which length is Most Accurate for Preprocedural Planning in Thoracic Endovascular Aortic Repair? Ann Vasc Surg 2021; 78:123-131. [PMID: 34437962 DOI: 10.1016/j.avsg.2021.05.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Automated centerline (CL) measurements have been conventionally used for stent-graft length estimation during thoracic endovascular aortic repair (TEVAR). The purpose of this study was to assess the accuracy of greater curvature length (GL), semiautomated CL and straightened centerline length (SCL) for preprocedural planning in TEVAR. METHODS Immediate postprocedural CT Angiographies of 30 patients (22 males, age-49.2 ± 10.1years) who underwent TEVAR between 2015 and 2017 were retrospectively analyzed. CL, GL, SCL and the straightline length(SL) were measured between proximal and distal ends of the stent-graft and results were compared with the true length of the stent-graft (TL). Tortuosity index (TI = CL/SL) was calculated. RESULTS GL (17.92 ± 4.78 cm) was the closest in predicting the TL (17.75 ± 4.29 cm) (P = 0.414) overall, as well as in both dissection and aneurysm subgroups (P= 0.9). There was a significant difference between CL (16.67 ± 4.07 cm) and TL (P< 0.0001) as well as between SCL (16.86 ± 4.16 cm) and TL (P= 0.001). These differences were greater in dissection subgroup than in the aneurysm group (P< 0.0001 and P= 0.03 for TL-CL and TL-SCL, respectively). The extent of mismatch between GL or CL and TL did not correlate with tortuosity, but the difference between TL and SCL had a significant positive correlation with tortuosity (r = 0.375, P= 0.04). TL-GL had a negative linear correlation with the stent-graft length (TL) in the dissection group (r = 0.50, P= 0.03). CONCLUSIONS The greater curvature length predicts the actual total length of the deployed stent-graft more accurately than centerline or straightened centerline lengths. Hence, it should be used in planning for the length of stent-graft required for TEVAR.
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Affiliation(s)
- Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Kartik P Ganga
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Aayush Goyal
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Ramakrishnan Reddy
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.
| | - Sanjiv Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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