Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy Michael C. Moon, MD,

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Presentation transcript:

Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy Michael C. Moon, MD, Roy K. Greenberg, MD, Jose P. Morales, MD, Zenia Martin, MD, Qingsheng Lu, MD, Joseph F. Dowdall, MD, Adrian V. Hernandez, MD, PhD Journal of Vascular Surgery Volume 53, Issue 4, Pages 942-949 (April 2011) DOI: 10.1016/j.jvs.2010.10.067 Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 1 Top row, A centerline reconstruction and (bottom row) orthogonal planes of a patient with a proximal reconstruction highlighting the various measurements recorded. The orthogonal plane refers to a plane perpendicular to the centerline at any point. Panel a demonstrates the aortic annulus in both a centerline reconstruction (red arrow) and orthogonal plane. Panel b similarly demonstrates the coronary arteries (red arrows), and Panel c shows the sinotubular junction (red arrow). Journal of Vascular Surgery 2011 53, 942-949DOI: (10.1016/j.jvs.2010.10.067) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2 Schematic of aortic root and ascending aorta demonstrates the location of the aortic annulus, the sinuses of Valsalva, the sinotubular junction, and the distal ascending aorta. Journal of Vascular Surgery 2011 53, 942-949DOI: (10.1016/j.jvs.2010.10.067) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 3 Flow chart shows the distribution of patients presenting with diagnoses of proximal aortic dissection to the Cleveland Clinic Foundation (CCF) between January 2004 and December 2006 based on clinical history and preoperative diagnostic assessment. CT, Computed tomography; MRI, magnetic resonance imaging; STJ, sinotubular junction. Journal of Vascular Surgery 2011 53, 942-949DOI: (10.1016/j.jvs.2010.10.067) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 4 The location of the intimal fenestration is plotted as the distance from the sinotubular junction (STJ) in millimeters. The point of the sinotubular junction is set at 0 mm, thus negative values represent intimal fenestrations within the aortic root. Journal of Vascular Surgery 2011 53, 942-949DOI: (10.1016/j.jvs.2010.10.067) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 5 The aorta was subdivided into quarters: greater curvature, lesser curvature, anterior, and posterior. Intimal fenestrations were identified as being proximal to the sinotubular junction (blue) or distal (purple). Most of the intimal fenestrations were located on the greater curvature. Journal of Vascular Surgery 2011 53, 942-949DOI: (10.1016/j.jvs.2010.10.067) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 6 A scatter plot shows the diameter vs length of the ascending aorta diameter at the sinotubular junction (STJ) and distal ascending aorta levels. Journal of Vascular Surgery 2011 53, 942-949DOI: (10.1016/j.jvs.2010.10.067) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 7 A scatter plot shows the location of the intimal fenestration vs the diameter of the sinotubular junction (STJ). The distance of the intimal fenestration is represented in millimeters relative to the STJ (x axis), and the diameter of the STJ junction is shown on the y axis in millimeters. The dashed lines on the x axis at +10 mm distal to the STJ and at 38 mm on the y axis represent the minimum distance required to have a proximal landing zone and the maximum aortic size based on available stent grafts, respectively. The lower right hand corner represents the potential cases identified by computed tomography that may be amenable to a stent graft repair of a proximal aortic dissection based on anatomic characteristics. Patients in the upper and lower left quadrants have unfavorable anatomy based on the location of the intimal fenestration, that is, <10 mm from the STJ or within the aortic root (proximal to the STJ). Patients located in the upper right quadrant are identified as having an intimal fenestration >10 mm from the STJ, but the aortic diameter is excessively large. Journal of Vascular Surgery 2011 53, 942-949DOI: (10.1016/j.jvs.2010.10.067) Copyright © 2011 Society for Vascular Surgery Terms and Conditions