Association between aortic arch angulation and bird-beak configuration after thoracic aortic stent graft repair of type B aortic dissection.

Abstract

OBJECTIVES:

The goal of this study was to investigate factors favouring the bird-beak configuration after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection.

METHODS:

We retrospectively analysed 76 patients with type B aortic dissection who underwent landing zone 1 and 2 TEVAR from December 2015 to January 2018. Preoperative aortic arch geometry (aortic arch length, maximal diameter and angulation), stent graft details and operative details were evaluated. A bird-beak configuration was defined as a ≥5-mm gap between the proximal end of the stent and the aortic wall of the lesser curvature.

RESULTS:

Patients were stratified into those with (n = 46) and without (n = 30) a bird-beak configuration. The baseline demographics, dissection chronicity, clinical features and implanted devices were largely similar between the 2 groups. No significant difference was observed in the arch length or maximal arch diameter. However, the mean aortic arch angulation was greater in patients with than without a bird-beak configuration (61.4° vs 51.3°; P < 0.001). No influence of either the stent graft brand or the proximal stent graft type was observed. The multivariable analysis showed that the aortic arch angulation was an independent risk factor for a bird-beak configuration (odds ratio 1.15, 95% confidence interval 1.07-1.24; P < 0.001). A cut-off angle of 59.15° was predictive of a bird-beak configuration (sensitivity 59%; specificity 77%).

CONCLUSIONS:

The preoperative aortic arch angulation was an independent predictor of a postoperative bird-beak configuration in patients with type B aortic dissection who underwent TEVAR that involved the aortic arch. An angle of >59.15° may imply a relatively hostile anatomy with a higher risk of a bird-beak configuration.

• Authors: Long Cao, Yangyang Ge, Yuan He, Xinhao Wang, Dan Rong, Weihang Lu, Xiaoping Liu, Wei Guo
• Journal: Interactive cardiovascular and thoracic surgery (Interact Cardiovasc Thorac Surg) Vol. 31 Issue 5 Pg. 688-696 (11 01 2020) ISSN: 1569-9285 [Electronic] England
• PMID: 33025008 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Topics

• Adult
• Aged
• Aortic Dissection (pathology, surgery)
• Aorta, Thoracic (diagnostic imaging, pathology)
• Aortic Aneurysm, Thoracic (pathology, surgery)
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation
• Endovascular Procedures
• Female
• Humans
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Retrospective Studies
• Risk Factors
• Stents
• Time Factors