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. 2018 Apr 19;13(4):e0196180.
doi: 10.1371/journal.pone.0196180. eCollection 2018.

Intravascular ultrasound assisted sizing in thoracic endovascular aortic repair improves aortic remodeling in Type B aortic dissection

Julia Lortz  1 , Konstantinos Tsagakis  2 , Christos Rammos  1 , Michael Horacek  1 , Thomas Schlosser  3 , Heinz Jakob  2 , Tienush Rassaf  1 , Rolf Alexander Jánosi  1
Affiliations

Intravascular ultrasound assisted sizing in thoracic endovascular aortic repair improves aortic remodeling in Type B aortic dissection

Julia Lortz et al. PLoS One. .

Abstract

The precise sizing of the stent graft in thoracic endovascular aortic repair (TEVAR) affects aortic remodeling and hence, further outcome. Covering the proximal entry tear is essential for successful treatment of Type B aortic dissection. Intravascular ultrasound (IVUS) enables real-time aortic diameter assessment, and is especially useful when computed tomography (CT) image quality is poor. IVUS, however, is not routinely utilized due to cost inefficiency. We investigated the impact of IVUS-assisted stent graft sizing on aortic remodeling in TEVAR. In this single-center retrospective study we evaluated patients with Type B aortic dissection undergoing both CT and IVUS before TEVAR. We assessed the aortic diameter at the level of the left subclavian artery via both methods before stent implantation and analyzed due to which method the implanted stent graft was chosen, retrospectively. To determine the degrees of aortic remodeling involved, we evaluated true lumen and false lumen diameters, and total aortic remodeling in CT. We analyzed 45 patients with Type B aortic dissection undergoing TEVAR. The mean ages were 66.9±10.0 years fo0072 IVUS (n = 20) and 62.3±14.2 years for CT-assisted TEVAR (n = 25; p = 0.226). The follow-up time for both groups did not differ between the two groups (IVUS: 22.9±23.1 months, CT: 25.6±23.0 months; p = 0.700). While both methods were associated with advantages regarding aortic remodeling, IVUS-assisted sizing yielded a greater increase in true lumen (30.4±6.2 vs. 25.6±5.3; p = 0.008) and reductions in false lumen (14.4±8.5 vs. 23.9±9.3; p = 0.001) and total aortic diameter (35.5±6.0 vs. 39.9±8.1; p = 0.045). IVUS-guided stent graft sizing in Type B aortic dissection shows beneficial effects on aortic remodeling and might be of additional advantage in aortic diseases, especially when CT image quality is poor.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Example for measurement of the aortic diameter at level of the left subclavian artery (LSA) with Type B aortic dissention (+).
CT (A) and IVUS (B) measurements at the level of the LSA (*). Penetraiting aortic ulcer (PAU) is shown in IVUS.
Fig 2
Fig 2. Example for assessment of aortic remodeling at the inferior edge of the stentgraft with sufficient remodeling (A) and impaired remodeling (B).
A: True lumen (*) is fully expanded, no false lumen is definable. B: False lumen (+) represents almost two-thirds of total aortic area at this intersection.
Fig 3
Fig 3. In more than 40%, intravascular ultrasound (IVUS) leads to a different sizing strategy in aortic stent grafts.
Shown are the distributions for changes in the sizing strategy made by IVUS in Valiant/Relay stent grafts (A) and GORE according to the recommended sizing chart (B). Further subdivision of the increases in stent graft sizes is presented in the smaller, right circles.
Fig 4
Fig 4. Aortic remodeling depending on sizing strategy.
Mean diameters and standard deviation for true lumen (TL), false lumen (FL) and total aorta (AD) are shown separately for the IVUS-guided (A) and CT-guided (B) group at baseline, one day after implantation (post) and follow-up. * differs significantly from baseline.
See this image and copyright information in PMC

References

    1. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014; 35: 2873–2926. doi: 10.1093/eurheartj/ehu281 - DOI - PubMed
    1. Hiratzka LF Invited commentary. Ann Thorac Surg. 2010; 90: 1521–1522. doi: 10.1016/j.athoracsur.2010.07.004 - DOI - PubMed
    1. Brunkwall J, Kasprzak P, Verhoeven E, Heijmen R, Taylor P, Trialists A, et al. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg. 2014; 48: 285–291. doi: 10.1016/j.ejvs.2014.05.012 - DOI - PubMed
    1. Nienaber CA, Kische S, Rousseau H, Eggebrecht H, Rehders TC, Kundt G, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013; 6: 407–416. doi: 10.1161/CIRCINTERVENTIONS.113.000463 - DOI - PubMed
    1. Leshnower BG, Duwayri YM, Chen EP, Li C, Zehner CA, Binongo JN, et al. Aortic Remodeling After Endovascular Repair of Complicated Acute Type B Aortic Dissection. Ann Thorac Surg. 2017; 103: 1878–1885. doi: 10.1016/j.athoracsur.2016.09.057 - DOI - PubMed

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