Impact of Thoracic Endovascular Repair on Pulsatile Aortic Strain in Acute Type B Aortic Dissection: Preliminary Results.

Santi Trimarchi,Ferdinando Auricchio,Michele Conti,Foeke Nauta,Frans Moll,Joost Van Herwaarden,Guido Van Bogerijen,Chiara Trentin

doi:10.12945/j.aorta.2017.16.042

Santi Trimarchi, Ferdinando Auricchio + Show 6 more

Open Access

PDF Available

https://doi.org/10.12945/j.aorta.2017.16.042

Copy DOI

Export

Save

Cite

Abstract
Highlights/Summary
Full-Text PDF
Similar Papers

Abstract

Listen

The impact of thoracic endovascular aortic repair (TEVAR) on pulsatile aortic strain remains undetermined in patients with Type B aortic dissection (TBAD). Therefore, we quantified pulsatile aortic strain in TBAD patients and control subjects. We retrospectively analyzed two TBAD patients from our database with cardiac-gated computed tomography angiography imaging available before and after TEVAR and two control subjects (67- and 76-year-old males). Patient 1 (54-year-old female) presented with acute TBAD, and Patient 2 (55-year-old male) had Marfan syndrome and ruptured acute TBAD. Custom-developed software was used to compute aortic length, diameter, and area during the cardiac cycle. Pulsatile strain was calculated as systolic increments of length and circumference divided by corresponding diastolic values. Before TEVAR, pulsatile longitudinal strain of the thoracic aorta was lower in TBAD patients (1.4-1.7%) than in control subjects (2.1-4.5%). After TEVAR, pulsatile longitudinal strain increased proximal to the stent-graft by 65% in the arch of Patient 1 and by 70% in the ascending aorta of Patient 2. Pulsatile circumferential strain was elevated in false lumen patency (4.4-6.2%) compared with thrombosed false lumen (1.4-2.1%) or control subjects (0.9-3.3%). Following TEVAR, circumferential measurements within stented segments were deemed unreliable due to artifacts. TEVAR led to a considerable increase of pulsatile longitudinal strain proximal to the stent-grafts, and TBAD was associated with longitudinally stiffer aortas, which may be part of the pathophysiology of TEVAR-related complications such as retrograde dissection and aneurysmal dilatation. These preliminary data call for larger prospective studies.

Highlights

Thoracic endovascular aortic repair (TEVAR) has been successfully adopted to treat complicated Type B aortic dissection (TBAD) [1]
TBAD patients showed lower pulsatile longitudinal strain of the total thoracic aorta before thoracic endovascular aortic repair (TEVAR) compared with control subjects
Patient 1, who presented with patent false lumen, showed higher strain of the true lumen when compared with Patient 2, who had a thrombosed false lumen

Summary

Introduction

Thoracic endovascular aortic repair (TEVAR) has been successfully adopted to treat complicated Type B aortic dissection (TBAD) [1]. Implantation of a rigid stent-graft in the proximal descending aorta might stiffen that segment, potentially forcing the ascending aorta and aortic arch to overstretch during each heartbeat, as we observed in a study of eight aneurysm patients managed with TEVAR (unpublished data) Such elevated wall stress has been associated with increased risk of aortic dissection [15] and aneurysm growth [5]. Conclusions: TEVAR led to a considerable increase of pulsatile longitudinal strain proximal to the stent-grafts, and TBAD was associated with longitudinally stiffer aortas, which may be part of the pathophysiology of TEVAR-related complications such as retrograde dissection and aneurysmal dilatation. These preliminary data call for larger prospective studies

Methods

Results

Conclusion