Risk Factor Analysis for the Mal-Positioning of Thoracic Aortic Stent Grafts

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• 作者：M. Boufi^a ; ^b ; ^c ; ^{mourad.boufi@ap-hm.fr" class="auth_mail" title="E-mail the corresponding author} ; C. Guivier-Curien^c ; B. Dona^b ; A.D. Loundou^d ; V. Deplano^c ; O. Boiron^c ; O. Hartung^b ; Y.S. Alimi^a ; ^b
• 关键词：Stent graft ; Mal-positioning ; Thoracic aorta ; Anatomy
• 刊名：European Journal of Vascular and Endovascular Surgery
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：52
• 期：1
• 页码：56-63
• 全文大小：1261 K

文摘

The present study aimed at quantifying mal-positioning during thoracic endovascular aortic repair and analysing the extent to which anatomical factors influence the exact stent graft positioning.

Methods

A retrospective review was conducted of patients treated between 2007 and 2014 with a stent graft for whom proximal landing zones (LZ) could be precisely located by anatomical fixed landmarks, that is LZ 1, 2, or 3. The study included 66 patients (54 men; mean age 51 years, range 17–83 years) treated for traumatic aortic rupture (n = 27), type B aortic dissection (n = 21), thoracic aortic aneurysm (n = 8), penetrating aortic ulcer (n = 5), intramural hematoma (n = 1), and floating aortic thrombus (n = 4). Pharmacologic hemodynamic control was systematically obtained during stent graft deployment. Pre- and post-operative computed tomographic angiography was reviewed to quantify the distance between planned and achieved LZ and to analyze different anatomical factors: iliac diameter, calcification degree, aortic angulation at the proximal deployment zone, and tortuosity index (TI).

Results

Primary endoleak was noted in seven cases (10%): five type I (7%) and two type II (3%). Over a mean 35 month follow up (range 3–95 months), secondary endoleak was detected in two patients (3%), both type I, and stent graft migration was seen in three patients. Mal-positioning varied from 2 to 15 mm. A cutoff value of 11 mm was identified as an adverse event risk. Univariate analysis showed that TI and LZ were significantly associated with mal-positioning (p = .01, p = .04 respectively), and that aortic angulation tends to reach significance (p = .08). No influence of deployment mechanism (p = .50) or stent graft generation (p = .71) or access-related factors was observed. Multivariate analysis identified TI as the unique independent risk factor of mal-positioning (OR 241, 95% CI 1–6,149, p = .05). A TI >1.68 was optimal for inaccurate deployment prediction.

Conclusion

TI calculation can be useful to anticipate difficulties during stent graft deployment and to reduce mal-positioning.