Abstract
BackgroundTo analyze the benefit of color-coded summation images in the assessment of target lumen perfusion in patients with aortic dissection and malperfusion syndrome before and after fluoroscopy-guided aortic fenestration.MethodsBetween December 2011 and April 2020 25 patients with Stanford type A (n = 13) or type B dissection (n = 12) and malperfusion syndromes were treated with fluoroscopy-guided fenestration of the dissection flap using a re-entry catheter. The procedure was technically successful in 100% of the cases and included additional iliofemoral stent implantation in four patients. Intraprocedural systolic blood pressure measurements for gradient evaluation were performed in 19 cases. Post-processed color-coded DSA images were obtained from all DSA series before and following fenestration. Differences in time to peak (dTTP) values in the compromised aortic lumen and transluminal systolic blood pressure gradients were analyzed retrospectively. Correlation analysis between dTTP and changes in blood pressure gradients was performed.ResultsMean TTP prior to dissection flap fenestration was 6.85 ± 1.35 s. After fenestration, mean TTP decreased significantly to 4.96 ± 0.94 s (p < 0.001). Available systolic blood pressure gradients between the true and the false lumen were reduced by a median of 4.0 mmHg following fenestration (p = 0.031), with significant reductions in Stanford type B dissections (p = 0.013) and minor reductions in type A dissections (p = 0.530). A moderate correlation with no statistical significance was found between dTTP and the difference in systolic blood pressure (r = 0.226; p = 0.351).ConclusionsHemodynamic parameters obtained from color-coded DSA confirmed a significant reduction of TTP values in the aortic target lumen in terms of an improved perfusion in the compromised aortic region. Color-coded DSA might thus be a suitable complementary tool in the assessment of complex vascular patterns prevailing in aortic dissections, especially when blood pressure measurements are not conclusive or feasible.
Highlights
Acute aortic dissection is a severe and life-threatening subtype of acute aortic syndrome that is characterized by significant mortality rates at 48 h [1]
This study retrospectively evaluates the utilization of color-coded Digital subtraction angiography (DSA) imaging in patients with malperfusion syndromes due to aortic dissection, that has been treated with percutaneous endoluminal aortic fenestration
Study cohort A review of the archives in our interventional radiology division resulted in 25 patients (13 men, 12 women) with aortic dissection and malperfusion syndromes who were consecutively treated by endovascular aortic fenestration between December 2011 and April 2020. 10 patients of the study population had been reported in another study series, in which the technique of fluoroscopy-guided balloon fenestration using a re-entry catheter was evaluated [10]
Summary
Acute aortic dissection is a severe and life-threatening subtype of acute aortic syndrome that is characterized by significant mortality rates at 48 h [1]. Endovascular aortic fenestration is an established minimally invasive approach that might be the treatment of choice in patients with severe malperfusion syndromes with or without previous aortic repair surgery [2]. The evaluation by intraluminal manometry might be unfeasible or unreliable in some cases This might be the case if the extent of the true lumen collapse impedes sufficient blood pressure measurement, leading to inconclusive or unaltered pressure gradients [7]. To analyze the benefit of color-coded summation images in the assessment of target lumen perfusion in patients with aortic dissection and malperfusion syndrome before and after fluoroscopy-guided aortic fenestration
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