Open AccessInfluence of measurement and sizing techniques in thoracic endovascular aortic repair on outcome in acute complicated type B aortic dissections
Author(s) -
Miriam Rychla,
Philip Dueppers,
Lorenz Meuli,
Zoran Rančić,
Anna-Leonie Menges,
Reinhard Kopp,
Alexander Zimmermann,
Benedikt Reutersberg
Publication year - 2021
Publication title -
interactive cardiovascular and thoracic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.546
H-Index - 56
eISSN - 1569-9293
pISSN - 1569-9285
DOI - 10.1093/icvts/ivab300
Subject(s) - medicine , interquartile range , aortic repair , aortic arch , stent , aortic dissection , radiology , hazard ratio , surgery , confidence interval , aneurysm , aorta
OBJECTIVES Thoracic endovascular aortic repair (TEVAR) is the first-line therapy in acute complicated type B aortic dissections (cTBAD). Nevertheless, no evidence-based consensus on the optimal measurement technique and sizing for TEVAR in cTBAD exists. The aim was to evaluate how different measurement and sizing techniques for TEVAR affect long-term outcomes. METHODS Retrospective analysis investigating the association between sizing and postoperative results after TEVAR in patients with cTBAD, treated between January 2003 and December 2020. Diameter measurements were performed perpendicular to a centreline in pre-interventional Computed tomography angiographies. Oversizing was determined by measuring aortic diameter in zone 2 of the aortic arch in relation to the implanted stent graft, and categorized into 2 sizing groups (≤10% and >10%). The primary outcome was freedom from aortic-related events. Secondary outcomes included mortality and a comparison of 3 alternative measurement techniques considering the estimated pre-dissection diameter. RESULTS Fifty-seven patients (median age 69, interquartile range 59.6–78.2 years) were included. Stent graft oversizing by ≤10% showed a trend towards fewer aortic-related events hazard ratio 0.455 (95% confidence interval 0.128–1.624, P = 0.225). The 3 measurement techniques using the pre-dissection aortic diameter differed by a mean of 1.7–4.0 mm with a variability of up to 8.4 mm. In none of the 57 patients, the same stent graft would have been chosen based on the different measurement techniques using an oversizing ≤10%. CONCLUSIONS TEVAR oversizing of ≤10% in patients with cTBAD might reduce aortic-related events up to 50%. Consensus on measurement techniques of the pre-dissection aortic diameter and stent graft sizing is of paramount importance.