Risk Factor Analysis for the Mal-Positioning of Thoracic Aortic Stent Grafts

被引:14
作者
Boufi, M. [1 ,2 ,3 ]
Guivier-Curien, C. [3 ]
Dona, B. [2 ]
Loundou, A. D. [4 ]
Deplano, V. [3 ]
Boiron, O. [3 ]
Hartung, O. [2 ]
Alimi, Y. S. [1 ,2 ]
机构
[1] Aix Marseille Univ, IFSTTAR, Marseille, France
[2] Univ Hosp Nord, APHM, Dept Vasc Surg, Marseille, France
[3] Aix Marseille Univ, Ecole Cent Marseille, CNRS, Marseille, France
[4] Aix Marseille Univ, Dept Publ Hlth, Marseille, France
关键词
Stent graft; Mal-positioning; Thoracic aorta; Anatomy; ACCURATE DEPLOYMENT; REPORTING STANDARDS; PRECISE DEPLOYMENT; ENDOGRAFTS; TORTUOSITY; REPAIR; IMPACT;
D O I
10.1016/j.ejvs.2016.03.025
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: The present study aimed at quantifying mal-positioning during thoracic endovascular aortic repair and analysing the extent to which anatomical factors influence the exact stent graft positioning. Methods: A retrospective review was conducted of patients treated between 2007 and 2014 with a stent graft for whom proximal landing zones (LZ) could be precisely located by anatomical fixed landmarks, that is LZ 1, 2, or 3. The study included 66 patients (54 men; mean age 51 years, range 17-83 years) treated for traumatic aortic rupture (n = 27), type B aortic dissection (n = 21), thoracic aortic aneurysm (n = 8), penetrating aortic ulcer (n = 5), intramural hematoma (n = 1), and floating aortic thrombus (n = 4). Pharmacologic hemodynamic-control was systematically obtained during stent graft deployment. Pre- and post-operative computed tomographic angiography was reviewed to quantify the distance between planned and achieved LZ and to analyze different anatomical factors: iliac diameter, calcification degree, aortic angulation at the proximal deployment zone, and tortuosity index (TI). Results: Primary endoleak was noted in seven cases (10%): five type I (7%) and two type II (3%). Over a mean 35 month follow up (range 3-95 months), secondary endoleak was detected in two patients (3%), both type I, and stent graft migration was seen in three patients. Mal-positioning varied from 2 to 15 mm. A cutoff value of 11 mm was identified as an adverse event risk. Univariate analysis showed that TI and LZ were significantly associated with mal-positioning (p = .01, p = .04 respectively), and that aortic angulation tends to reach significance (p = .08). No influence of deployment mechanism (p = .50) or stent graft generation (p = .71) or access-related factors was observed. Multivariate analysis identified TI as the unique independent risk factor of mal-positioning (OR 241, 95% CI 1-6,149, p = .05). A TI >1.68 was optimal for inaccurate deployment prediction. Conclusion: TI calculation can be useful to anticipate difficulties during stent graft deployment and to reduce mal-positioning. (C) 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:56 / 63
页数:8
相关论文
共 17 条
[1]   The Role of Anatomic Factors in Predicting Success of Endovascular Repair of Thoracic Aortic Aneurysms [J].
Bowman, Jonathan N. ;
Silverberg, Daniel ;
Ellozy, Sharif ;
Teodorescu, Victoria ;
Poblete, Honesto ;
Marin, Michael ;
Faries, Peter .
VASCULAR AND ENDOVASCULAR SURGERY, 2010, 44 (02) :101-104
[2]   Identifying and grading factors that modify the outcome of endovascular aortic aneurysm repair [J].
Chaikof, EL ;
Fillinger, MF ;
Matsumura, JS ;
Rutherford, RB ;
White, GH ;
Blankensteijn, JD ;
Bernhard, VM ;
Harris, PL ;
Kent, KC ;
May, J ;
Veith, FJ ;
Zarins, CK .
JOURNAL OF VASCULAR SURGERY, 2002, 35 (05) :1061-1066
[3]   Impact on outcomes by measuring tortuosity with reporting standards for thoracic endovascular aortic repair [J].
Chen, Chun-Ku ;
Liang, I-Ping ;
Chang, Hsiao-Ting ;
Chen, Wei-Yuan ;
Chen, I-Ming ;
Wu, Mei-Han ;
Sheu, Ming-Huei ;
Shih, Chun-Che .
JOURNAL OF VASCULAR SURGERY, 2014, 60 (04) :937-944
[4]   TRANSLUMINAL PLACEMENT OF ENDOVASCULAR STENT-GRAFTS FOR THE TREATMENT OF DESCENDING THORACIC AORTIC-ANEURYSMS [J].
DAKE, MD ;
MILLER, DC ;
SEMBA, CP ;
MITCHELL, RS ;
WALKER, PJ ;
LIDDELL, RP .
NEW ENGLAND JOURNAL OF MEDICINE, 1994, 331 (26) :1729-1734
[5]   Intraoperative C-arm cone-beam computed tomography in fenestrated/branched aortic endo grafting [J].
Dijkstra, Martijn L. ;
Eagleton, Matthew J. ;
Greenberg, Roy K. ;
Mastracci, Tara ;
Hernandez, Adrian .
JOURNAL OF VASCULAR SURGERY, 2011, 53 (03) :583-590
[6]   High-dose adenosine-induced asystole assisting accurate deployment of thoracic Stent grafts in conscious patients [J].
Fang, Tony D. ;
Lippmann, Maurice ;
Kakazu, Clayton ;
Donayre, Carlos E. ;
Bui, Hao ;
Kopchok, George E. ;
White, Rodney A. .
ANNALS OF VASCULAR SURGERY, 2008, 22 (05) :602-607
[7]   Reporting standards for thoracic endovascular aortic repair (TEVAR) [J].
Fillinger, Mark F. ;
Greenberg, Roy K. ;
McKinsey, James F. ;
Chaikof, Elliot L. .
JOURNAL OF VASCULAR SURGERY, 2010, 52 (04) :1022-1033
[8]  
Ishimaru S, 2004, J ENDOVASC THER, V11, P62
[9]  
Ito Eisaku, 2015, Ann Vasc Dis, V8, P74, DOI 10.3400/avd.oa.14-00141
[10]   Maldeployment of the TAG thoracic end graft [J].
Lee, W. Anthony ;
Martin, Tomas D. ;
Hess, Philip J. ;
Beaver, Thomas M. ;
Huber, Thomas S. .
JOURNAL OF VASCULAR SURGERY, 2007, 46 (05) :1032-1035