Results of Thoracic Endovascular Grafting in Different Aortic Segments

The apex of the aortic arch backshifts with aging

BACKGROUND

Only a few studies, involving small numbers of patients, have globally assessed the curvature of the thoracic aorta but without any details concerning the location of the supra-aortic trunks.

OBJECTIVES

Using CT to describe normal aortic-arch morphology and its changes with age and sex.

METHODS

344 CT scans were studied. We measured the distances from the apex to the ascending and descending aorta, the curvilinear length of the entire arch, that of the segment, including bifurcations of supra-aortic vessels, and the angle, height, and shift of the arch.

RESULTS

In men, the arch was significantly longer (146.2 vs 122.8 mm; p < 0.001), higher (49.3 vs 40.1 mm, p < 0.001), and wider transversely (83.6 vs 73.3 mm; p < 0.001) than in women. The average men's arch also had a more acute angle at the apex (79.7° vs 83.7° p < 0.001). Neither morphology nor age influenced the winding angle around the mediastinum. Aging was accompanied by deflection and extension of the aortic arch, which grew more anteroposteriorly (6.1 mm/10 years in men) than vertically (2.5 mm/10 years in men), while the apex moved towards the rear of the arch. The ascending aorta was the only curvilinear length unaffected by age, whereas the supra-aortic trunks parted from each other.

CONCLUSION

We believe that all these original observations could lead to a better assessment of normal aging of the aorta and guide technical choices during surgical or hybrid procedures.

Repair of multiple aneurysms of the thoracic aorta with a hybrid prosthesis

Complex aneurysmal disease of the thoracic aorta is commonly treated with the elephant trunk technique using two-stage surgery. However, this procedure is associated with high morbidity and mortality. We present the surgical technique used to correct diffuse aneurysmal aortic disease that involves the aortic arch and the descending aorta. The frozen elephant trunk technique using the E-vita Open prosthesis (hybrid procedure), that combines surgical and interventional technologies, was useful to simplify the conventional surgical procedure in a single-stage approach with optimal results.