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A New Murine Model of Endovascular Aortic Aneurysm Repair
Published on: July 7, 2013
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Risk Factor Analysis of Bird Beak Occurrence after Thoracic Endovascular Aortic Repair
M Boufi1, C Guivier-Curien2, V Deplano3
1Aix-Marseille Université, CNRS, Centrale Marseille, Marseille, France; Department of Vascular Surgery, APHM, University Hospital Nord, Marseille, France; IFSTTAR, Aix-Marseille Université, Marseille, France.
Summary
Anatomical factors, specifically aortic angle, significantly influence stent graft malapposition during thoracic endovascular aortic repair. Avoiding deployment zones with angles over 50° can improve apposition with current devices.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Biomedical Engineering
Background:
- Thoracic endovascular aortic repair (TEVAR) is a common treatment for aortic arch pathologies.
- Incomplete stent graft apposition, or 'bird beak', can lead to complications.
- Understanding factors contributing to malapposition is crucial for improving TEVAR outcomes.
Purpose of the Study:
- To investigate the role of patient anatomy and stent graft characteristics in the incidence of incomplete stent graft apposition in the aortic arch.
- To identify anatomical predictors of malapposition during TEVAR.
Main Methods:
- Retrospective review of computed tomographic angiography (CTA) data from 80 patients undergoing TEVAR between 2007 and 2014.
- Analysis of pre- and post-operative CTA to measure 'bird beak' dimensions and aortic angulation at the proximal landing zone.
- Multivariate analysis to identify independent risk factors for malapposition.
Main Results:
- 'Bird beak' malapposition was observed in 57% of patients.
- Aortic angle of the deployment zone was identified as the sole independent risk factor for malapposition (HR=1.05, p=0.005).
- An aortic angle cutoff of 51° predicted 'bird beak' occurrence with 58% sensitivity and 85% specificity.
Conclusions:
- Proximal landing zone morphology, particularly aortic angulation, is a critical determinant of stent graft apposition.
- Pre-operative assessment of aortic angle can help predict and potentially avoid malapposition.
- Recommending avoidance of deployment zones with aortic angles exceeding 50° may improve outcomes with current TEVAR devices.
