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Thoracic aortic geometry correlates with endograft bird-beaking severity.

Maxfield M Frohlich1, Ga-Young Suh2, Johan Bondesson3

  • 1Biomedical Engineering Department, San Jose State University, San Jose, Calif.

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|February 10, 2020
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Summary

High preoperative aortic inner curvature and diameter increase the risk of endograft malapposition (bird-beaking) after thoracic endovascular aortic repair (TEVAR). Geometric modeling can quantify and predict this complication, aiding in patient selection and procedural planning.

Keywords:
Aortic archBird beak configurationEndograftEndoleakThoracic endovascular aortic repair

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Area of Science:

  • Cardiovascular Surgery
  • Medical Imaging
  • Biomechanical Engineering

Background:

  • Endograft malapposition, or bird-beaking, is a known complication of thoracic endovascular aortic repair (TEVAR).
  • Aortic geometry is suspected to influence bird-beaking, but the precise relationship and predictive factors remain unclear.

Purpose of the Study:

  • To develop a reproducible method for quantifying the severity of TEVAR bird-beaking.
  • To identify specific preoperative aortic geometric parameters associated with the development of bird-beaking.

Main Methods:

  • Retrospective analysis of 20 patients undergoing TEVAR for thoracic aortic aneurysms or type B dissections.
  • Creation of 3D geometric models from preoperative and postoperative CT scans to measure bird-beaking.
  • Correlation of quantified bird-beak severity (length, height, angle) with preoperative aortic geometry (area, curvature, diameter) and graft oversizing.

Main Results:

  • No significant differences in aortic area, inner curvature, or diameter were found between groups with and without bird-beaking.
  • A significantly higher combined metric of inner curvature × diameter was observed in patients with bird-beaking (P = .030).
  • Both inner curvature and the inner curvature × diameter product showed significant correlations with bird-beak height and angle (P < .05).

Conclusions:

  • TEVAR bird-beak severity can be reliably quantified and predicted using geometric modeling.
  • A combination of high preoperative aortic inner curvature and diameter is a significant risk factor for developing TEVAR bird-beaking.