The impact of bird-beak configuration on aortic remodeling of distal arch pathology after thoracic endovascular aortic repair with the Zenith Pro-Form.

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Presentation transcript:

The impact of bird-beak configuration on aortic remodeling of distal arch pathology after thoracic endovascular aortic repair with the Zenith Pro-Form TX2 thoracic endograft Hung-Lung Hsu, MD, Chun-Ku Chen, MD, Po-Lin Chen, MD, I-Min Chen, MD, Chiao-Po Hsu, MD, PhD, Chih-Wen Chen, MD, Chun-Che Shih, MD, PhD Journal of Vascular Surgery Volume 59, Issue 1, Pages 80-88 (January 2014) DOI: 10.1016/j.jvs.2013.07.098 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 Calculation of angulation. A, Three-dimensional reconstruction image. B, Illustration of vector inner product (a⇀·b⇀=|a⇀||b⇀|cosθ). Journal of Vascular Surgery 2014 59, 80-88DOI: (10.1016/j.jvs.2013.07.098) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Calculation of bird-beak angulation. A, Straight multiplanar reconstruction image. B, The cross-section view shows that the tip of the graft and that the distance (D) from the tip of the stent graft to the aortic wall is 7.55 mm. C, The projecting length (L) of the bird-beak configuration was measured along the aortic wall until the stent graft attached to the wall without a gap. D, Illustration of tan Φ = D/L. Journal of Vascular Surgery 2014 59, 80-88DOI: (10.1016/j.jvs.2013.07.098) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 Angle remodeling with each point presented as the mean angle degree with the standard error (range bars) for the (A) Pro-Form and (B) Z-Trak stents. INM, Innominate artery; LCCA, left common carotid artery; LSA, left subclavian artery. Journal of Vascular Surgery 2014 59, 80-88DOI: (10.1016/j.jvs.2013.07.098) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 Significant angulation transformation is shown between the Pro-Form group and Z-Trak group for (A) zone 2 and (B) the left subclavian artery (LSA). Each point presented is the mean angle degree with the standard deviation (range bar). Journal of Vascular Surgery 2014 59, 80-88DOI: (10.1016/j.jvs.2013.07.098) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 5 Comparison of bird-beak angle is shown at different periods of follow-up for the Pro-Form and Z-Trak stents. Each point presented is the mean angle degree with the standard deviation (range bar). Journal of Vascular Surgery 2014 59, 80-88DOI: (10.1016/j.jvs.2013.07.098) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 6 Receiver operating characteristic (ROC) curve and the area under the curve (AUC) are shown for the preoperative angle of zone 2 in the dissection group. Journal of Vascular Surgery 2014 59, 80-88DOI: (10.1016/j.jvs.2013.07.098) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 7 Follow-up images after thoracic endovascular aortic repair (TEVAR) with the Pro-Form stent graft show a stable distal arch angle and proper apposition of the stent graft to the inner curve of aortic arch. A, A sagittal-view computed tomography image shows the thoracic aorta. B, Three-dimensional reconstruction image shows the median centerline (green line) and the distal arch angle (red angle). C, Straight multiplanar reconstruction image shows the median centerline (green line) and apposition of the stent graft to the inner curve of the aortic arch (red circle). Journal of Vascular Surgery 2014 59, 80-88DOI: (10.1016/j.jvs.2013.07.098) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 8 Sequential images of a Z-Trak stent graft with bird-beak configuration show the enlarged distal arch angle (red angle) and worsening apposition of the stent graft to the inner curve of the aortic arch (red circle). A, A sagittal-view computed tomography image shows the thoracic aorta. B, Three-dimensional reconstruction image shows the median centerline (green line) and the distal arch angle (red angle). C, Straight multiplanar reconstruction image shows the median centerline (green line) and apposition of the stent graft to the inner curve of aortic arch (red circle). Journal of Vascular Surgery 2014 59, 80-88DOI: (10.1016/j.jvs.2013.07.098) Copyright © 2014 Society for Vascular Surgery Terms and Conditions