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Aortic Neck Dilatation Following Thoracic Endovascular Aortic Repair
Patricia Yau1, Evan C Lipsitz1, Patricia Friedmann2
1Division of Vascular and Endovascular Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY.
Annals of Vascular Surgery
|May 18, 2021
Summary
Thoracic endovascular aortic repair (TEVAR) can lead to aortic neck dilatation over time, particularly in the distal region. Dissection, landing zone 2 graft placement, and smoking increase this risk.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Aortic Disease Management
Background:
- Thoracic endovascular aortic repair (TEVAR) is a primary treatment for thoracic aortic pathologies.
- Proximal aortic neck expansion is known after abdominal aortic aneurysm repair but less described after TEVAR.
- Understanding TEVAR's effect on the proximal aortic neck is crucial for long-term outcomes.
Purpose of the Study:
- To characterize aortic neck remodeling after TEVAR.
- To identify factors associated with proximal aortic neck dilatation post-TEVAR.
Main Methods:
- Retrospective review of 30 patients undergoing TEVAR for thoracic aortic aneurysm or dissection (2010-2019).
- Aortic diameter measured from postoperative CT scans using 3D centerline reconstruction.
- Analysis of clinical and operative data to correlate with neck dilatation.
Main Results:
- Aortic diameter increased over time in most patients, with the greatest expansion 5 mm distal to the graft.
- Median expansion at this site reached 6.2 mm by 3 years.
- Higher expansion rates (>2.0 mm/year) were linked to dissection pathology, landing zone 2 placement, and smoking.
Conclusions:
- Aortic neck dilatation is a common finding after TEVAR, most pronounced distally.
- Factors such as dissection, landing zone 2, and smoking are associated with increased neck dilatation.
- These findings highlight the need for vigilant surveillance after TEVAR.
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