Morphologic performance analysis of the Relay nonbare stent graft in dissected thoracic aorta
Autor: | Christian Schlensak, Mario Lescan, Friedhelm Beyersdorf, Bartosz Rylski, Mateja Andic, Martin Czerny, Mikolaj Berezowski, Fabian Bamberg |
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Rok vydání: | 2019 |
Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment False lumen Aorta Thoracic Vascular Remodeling 030204 cardiovascular system & hematology Blood Vessel Prosthesis Implantation 03 medical and health sciences Imaging Three-Dimensional Postoperative Complications 0302 clinical medicine Risk Factors Interquartile range Germany medicine.artery medicine Humans Thoracic aorta In patient 030212 general & internal medicine Aged Retrospective Studies Aortic Aneurysm Thoracic business.industry Incidence Endovascular Procedures Stent Middle Aged medicine.disease Thrombosis Surgery Aortic Dissection Apposition Dissection Treatment Outcome surgical procedures operative Female Stents Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Follow-Up Studies |
Zdroj: | Journal of Vascular Surgery. 70:1390-1398 |
ISSN: | 0741-5214 |
Popis: | The aim of this study was to evaluate morphologic changes in dissected aortas after thoracic endovascular aortic repair (TEVAR) with the use of the Relay Nonbare stent graft stent graft by focusing on the geometric stent graft's performance in remodeling aortas.We conducted a retrospective three-dimensional computed tomography analysis preoperatively, postoperatively, and 6 months after TEVAR in patients with residual dissection after type A and those with acute and chronic type B dissections at two German centers.Thirty-nine acute and 54 chronic aortic dissections were included. Median follow-up was 200 (interquartile range, 109-617) days. TEVAR induced aortic remodeling in both groups. Complete false lumen thrombosis along the stent graft (postoperative, 73%; follow-up, 84%; P .0001) led to a decrease in aortic diameter at the middle stent graft level (preoperative, 45.9 mm [38.6-56.6] vs follow-up, 43.6 [37.4-52.4] mm; P = .009). True lumen expansion was observed in both groups and peaked in acute dissections in the distal landing zone (acute, +9.3 mm vs chronic, +5.8 mm; P .0001). Migration was 2 (0-5) mm, and bird-beak and endoleak type IA rates were 20% and 4%, respectively. There was no retrograde type A dissection. Distal stent graft-induced new entry occurred in 15%; the major risk factor for incidence was the stent graft's wedge apposition angle (odds ratio, 1.365 [confidence interval, 1.115-1.671]; P = .003).TEVAR with the use of the Relay NBS promotes aortic remodeling in acute and chronic dissections, entailing a low risk of migration, type IA endoleaks, and retrograde type A dissections. Wedge apposition was the predominant risk factor for distal stent graft-induced new entry. |
Databáze: | OpenAIRE |
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