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Proximal Neck Diameter Changes Following Zone 0 TEVAR With or Without Ascending Aortic Wrapping
Takayuki Shijo1, Kazuo Shimamura1, Koichi Maeda1
1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Background:
In zone 0 thoracic endovascular aortic repair (TEVAR), ascending aortic wrapping for a moderately dilated ascending aorta may stabilize the proximal landing zone. This study evaluated serial changes in proximal aortic diameter after zone 0 TEVAR and explored the potential stabilizing effect of ascending aortic wrapping.
Methods:
This retrospective, single-center study included 108 patients with degenerative aortic arch aneurysms who underwent zone 0 TEVAR between 2008 and 2022. Thirty patients received concomitant ascending aortic wrapping (group W) and 78 underwent TEVAR without wrapping (group N). We assessed serial changes in ascending aortic diameter at the proximal neck.
Results:
Preoperative proximal neck diameter was larger in group W (median 39 mm [IQR 38-41]) than in group N (34 mm [IQR 32-36]; p < .001), and it decreased to 30 mm [IQR 28-31] after wrapping. In group W, diameter increased significantly during the first postoperative year (2.5 mm/year; 95% CI 1.9-3.0; p < .001), then slowed yet showed a continued upward trend (0.17 mm/year; 95% CI 0.04-0.31; p = .018). In group N, the growth rate was 0.57 mm/year (95% CI 0.21-0.92; p = .002) in year one and 0.42 mm/year (95% CI 0.18-0.67; p = .001) thereafter. At 5 years, cumulative incidence of late type Ia endoleak was 0% in group W versus 14% (95% CI 5-31%) in group N.
Conclusions:
Ascending aortic wrapping during zone 0 TEVAR may attenuate proximal neck enlargement.
