Incomplete Endograft Apposition to the Aortic Arch: Bird-Beak Configuration Increases Risk of Endoleak Formation after Thoracic Endovascular Aortic Repair
Incomplete Endograft Apposition to the Aortic Arch: Bird-Beak Configuration Increases Risk of Endoleak Formation after Thoracic Endovascular Aortic Repair
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DOI：
10.1148/radiol.10091468
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发表时间：
2010-05-01
期刊：
影响因子：
19.7
通讯作者：
Sze, Daniel Y.
中科院分区：
文献类型：
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作者：
Ueda, Takuya;Fleischmann, Dominik;Sze, Daniel Y.
目的：确定胸主动脉腔内修复术(TEVAR)后鸟喙形态的临床意义。材料和方法：机构评审委员会批准了这项回顾性研究，并免除了征得患者知情同意的要求。对64例接受TEVAR的患者(男40例，女24例；平均年龄岁)进行了评估。其中夹层29例，退行性动脉瘤13例，急性外伤性横断8例，假性动脉瘤4例，穿透性主动脉溃疡6例，壁内血肿2例，霉菌性动脉瘤2例。通过术后CT血管造影术评估鸟喙形态，鸟喙形态被定义为近端内移植物的不完全对位，在装置与主动脉壁之间有楔形间隙。结果：患者中有26例(40%)检出内漏，其中Ia型14例，Ib型1例，II型6例(左锁骨下动脉)，IIO型2例(其他动脉)，IIO型3例。在患者中有28例(44%)观察到鸟喙形态，并与发生Ia型或IIa型内漏的风险显著相关(P<；0.01)。Ia型或II型内漏患者的平均鸟喙长度(平均长度分别为14.3 mm和13.9 mm)显著长于无内漏患者(平均长度为8.4 mm)。不良事件包括3例患者早期与主动脉相关的死亡，8例额外治疗内漏，6例支架移植物塌陷或内陷。结论：检测鸟喙形态有助于预测TEVAR后的不良临床事件。(C)RSNA，2010年
Purpose: To determine the clinical importance of the bird-beak configuration after thoracic endovascular aortic repair (TEVAR).Materials and Methods: The institutional review board approved this retrospective study and waived the requirement to obtain informed consent from patients. Sixty-four patients (40 men, 24 women; mean age, 64 years) who underwent TEVAR were evaluated. The treated diseases included dissection (n = 29), degenerative aneurysm (n = 13), acute traumatic transection (n = 8), pseudoaneurysm (n = 4), penetrating aortic ulcer (n = 6), intramural hematoma (n = 2), and mycotic aneurysm (n = 2). Bird-beak configuration, defined as the incomplete apposition of the proximal endograft with a wedge-shaped gap between the device and the aortic wall, was assessed with postprocedural CT angiography. The presence and length of the bird-beak configuration were compared with the formation of endoleaks and adverse clinical events.Results: Endoleaks were detected in 26 (40%) of the 64 patients, including 14 with type Ia endoleak formation, one with type Ib endoleak formation, six with type II endoleak formation (from the left subclavian artery), two with type IIo endoleak formation (from other arteries), and three with type III endoleak formation. Bird-beak configuration was observed in 28 (44%) of 64 patients and correlated significantly with the risk of developing a type Ia or IIa endoleak (P < .01). Mean bird-beak length was significantly longer (P < .01) in patients with a type Ia or II endoleak (mean length, 14.3 and 13.9 mm, respectively) than in patients without endoleaks (mean length, 8.4 mm). Adverse events included early aortic-related death in three patients, additional treatment for endoleak in eight patients, and stent-graft collapse or infolding in six patients.Conclusion: Detection of bird-beak configuration is helpful in the prediction of adverse clinical events after TEVAR. (C) RSNA, 2010