The Modified Arch Landing Areas Nomenclature identifies hostile zones for endograft deployment: a confirmatory biomechanical study in patients treated by thoracic endovascular aortic repair†

Autor: Marrocco-Trischitta, M. M., Romarowski, R. M., De Beaufort, H. W., Conti, M., Vitale, R., Secchi, F., Auricchio, F., Trimarchi, S., Bonardelli, S.
Rok vydání: 2018
Předmět:
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Computed Tomography Angiography
Pulsatile flow
Hemodynamics
Aorta
Thoracic
Arch angulation
Computational fluid dynamics
Endovascular planning
Modified Aortic Landing Areas Nomenclature (MALAN)
Thoracic aorta endovascular repair
030204 cardiovascular system & hematology
Aortic repair
Preoperative care
Blood Vessel Prosthesis Implantation
03 medical and health sciences
0302 clinical medicine
Aneurysm
Terminology as Topic
medicine.artery
medicine
Humans
Arch
Aged
Retrospective Studies
Computed tomography angiography
Aged
80 and over
Aorta
Aortic Aneurysm
Thoracic
medicine.diagnostic_test
business.industry
Endovascular Procedures
Models
Cardiovascular
General Medicine
Middle Aged
medicine.disease
Biomechanical Phenomena
Blood Vessel Prosthesis
Surgery
030228 respiratory system
Radiographic Image Interpretation
Computer-Assisted
Female
Cardiology and Cardiovascular Medicine
business
Zdroj: European Journal of Cardio-Thoracic Surgery. 55:990-997
ISSN: 1873-734X
1010-7940
Popis: Objectives Our goal was to confirm whether the Modified Arch Landing Areas Nomenclature (MALAN) for thoracic endovascular aortic repair, in which each landing area is described by indicating both the proximal landing zone (PLZ) and the type of arch (e.g. 0/I), identifies unfavourable landing zones for endograft deployment in diseased aortas. Methods Preoperative computed tomography angiography scans of 10 patients scheduled for thoracic endovascular aortic repair for aneurysm or penetrating ulcer of the arch and with a potential hostile PLZ were reviewed. Five had proximal deployment planned in MALAN area 3/III and 5, in MALAN area 2/III. The angulation of each PLZ was calculated. Computational fluid dynamics modelling was used to compute magnitude and orientation of pulsatile displacement forces in each PLZ. Normalized values based on PLZ areas (i.e. equivalent surface traction) were calculated. Results were compared to those obtained in healthy controls stratified by the MALAN. Results Angulation was severe (>60°) in MALAN areas 3/III and 2/III, which was consistent with the findings obtained in healthy controls. Increased magnitude (P = 0.021) and unfavourable orientation (i.e. orthogonal to the longitudinal aortic axis) of equivalent surface traction (P = 0.011) was also found in these areas compared to the adjacent ones, following the same pattern seen in the controls. Adverse events related to proximal endograft performance were reported in 3/10 cases. Conclusions This study confirms in diseased aortas initial proof-of-concept findings on the predictive value of the MALAN to identify landing areas with a geometric and haemodynamic environment hostile for thoracic endovascular aortic repair. These adverse biomechanical features may entail an increased risk of dismal endograft performance.
Databáze: OpenAIRE
Externí odkaz: