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Objective To evaluate midterm outcomes of thoracic endovascular aortic repair (TEVAR) with in situ fenestration (ISF) to revascularize the aortic arch vessels.Methods From Feb 2012 to Dec 2014,10 patients underwent TEVAR with aortic arch vessels revascularized via ISF.There were 6 patients of thoracic aortic aneurysms (TAA) and 4 of type B aortic dissection (TBAD).Patients were followed for all-cause mortality,endoleak of post-TEVAR,integrity and patency of aortic endograft and branch vessels.Results Totally 11 branch vessels [10 left subclavian arteries (LSA),1 left common carotid artery (LCA)] via ISF were revascularized in 10 patients.Patients were followed-up for 24-55 mouths,mean of 42.80 months.1 TAA patient died in 2 years post-TEVAR unrelated to the operation.All fenestrations remained patent,and there were no endoleaks and no occlusion,compression,or fracture of stents.There were no postoperative strokes and left upper limbs ischemia.1 patient had distal aortic endograft pseudoaneurysms formation in 2 years post-TEVAR and underwent reTEVAR treatment.Conclusion Aortic arch vessels revascularization via ISF in TEVAR is safe and feasible.Midterm outcomes is satisfactory.
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Objective To study the changes in the diameter of the ascending aorta at different levels.Methods A total of 287 patients were enrolled in this study from November 2016 to January 2017 at the Chinese People's Liberation Army General Hospital in Beijing.Each patient had undergone enhanced computerized tomography scanning,and the systolic and diastolic images were reconstructed for each patient.Ten times distance accounts for percentage was calculated per 10％ unit of ascending aorta.The maximal diameters of each level were measured by 3 mensio Vascular 8.1 software with curved planar reformation.Generalized additive mixed model with smoothing function and threshold saturation effect analysis with generalized estimating equations were used to analysis the changing regularity of ascending aortic diameters and its consistency using stratified analysis.Furthermore,stratified analyses were conducted aauording to sex,age,BMI,smoking status and history of chronic diseases.Results A nonlinear relationship between the maximal diameters and distance was observed.With the increase of distance,the maximal diameters of ascending aorta presented an inverted U shape.In the first half,the ascending aortic maximal diameter increased 1.16 mm while the distance increased ten percent of the ascending aortic length (P ＜ 0.001).In the second half,the ascending aortic maximal diameter reduced 0.47 mm while the distance increased ten percent of the ascending aortic length (P ＜ 0.001).The results showed that the changing regularity of ascending aortic diameter has no significant difference between systolic and diastolic periods.Conclusions With the increase of distance,the maximal diameters of ascending aorta increase and then decrease.The regularity of ascending aortic diameter between systole and diastole is consistent.In each subgroup,the regularity of ascending aortic diameter is not completely consistent,but the difference has not clinical significance.
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Objective To characterize the changes in the dimensions during systolic and diastolic periods in the aorta with ECG-gated multi-detector CTA scans.Methods The CT angiograms of 115 patients (78 males,mean age 55.2 ± 9.4 years;37 females,mean age 60.1 ± 8.5 years) both in systolic and diastolic periods were obtained on a 64-slice ECG-gated multi-detector CT scanner.The diameters were measured at four anatomic levels of the aorta.(Level A:1 mm proximal to the innominate artery;Level B:1 mm distal to the left common carotid artery;Level C:1 mm distal to the left subclavian artery;Level D:10cm distal to the left subclavian artery).On each level,the maximal and the minimal diameters were measured both in systolic and diastolic periods.Results The paired sample t test results showed a significant difference between the systolic and diastolic diameters in all individual subjects on every level (P ＜0.001).The mean maximum diameter changes were 1.95％ (range-2.0％ to 7.0％),2.12％ (range-3.0％ to 6.0％),1.88％(range-1.0％ to 8.0％)and2.47％(range-3.0％ to 10.0％)at level A,B,C and D,respectively.The mean minimum diameter changes were 1.43％ (range-3.0％ to 5.0％),2.67％ (range-2.0％ to 11.0％),1.75％ (range-14.0％ to 9.0％)and 2.99％ (range -2.0％ to 11.0％) at level A,B,C and D,respectively.Conclusions The differences of the aortic diameters between systolic and diastolic periods are significant.The pulsatility of aorta in Chinese population may be different from published Western literature.
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Endovascular repair has gained worldwide popularity for the treatment of aortic dissection and aortic aneurysm.The non-tapered stents are selected usually.The aortic diameters vary in different level.High incidence of distal stent-induced complications is closely related to the aortic taper angle.According to several published studies,the aortic taper angle could be evaluated by establishing geometric model.Applications of tapered stents can significantly reducing the incidence of distal stent-induced comnplications.This review summaries the latest researches in the studies of the progress and the application of the aortic taper angle and the tapered stents,providing a reference for endovascular stent-graft selecting in the treatment of aortic dissection and aortic aneurysm.