European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025
Anatomic predictors of distal landing zone failure after endovascular repair of thoracic aortic aneurysm†.
СтатьяНазвание и аннотация: Перевод в очереди
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Goel Nicholas J, Peev Andrew M, Auteri Peter, Wang Grace J, Lawrence Kendall M, Sperry Alexandra E, Berezowski Mikolaj, Yildiz Murat, Lutfi Waseem, DePaolo John, Zhao Yu, Fairman Alexander S, Szeto Wilson Y, Schneider Darren B, Desai Nimesh D
Аннотация
OBJECTIVES: To analyse anatomic factors of the distal landing zone (dLZ) associated with the durability of endovascular repair of thoracic aortic aneurysm (TAA).
METHODS: Consecutive patients undergoing thoracic endovascular aortic repair (TEVAR) for undissected TAA were queried from a single centre from 2004 to 2022. Patient and operative factors were considered as well as detailed anatomic factors at the dLZ assessed by 3D reconstruction of pre-TEVAR imaging. The outcome of interest was the long-term risk of TEVAR failure at the dLZ.
RESULTS: A total of 101 patients undergoing TEVAR repair of TAA were considered, of whom 17 suffered distal TEVAR failure over a median follow-up period of 2.7 years. Two anatomic factors showed outsized influence on long-term outcomes: dLZ diameter and dLZ length (the length of non-dilated aortic tissue above the coeliac artery). Patients who progressed to distal TEVAR failure had larger dLZ diameter (34.2 mm vs 30.7 mm, P = 0.034) and far shorter dLZ length (3.8 cm vs 7.5 cm, P = 0.008). Patients with dLZ diameter greater than 35 mm had much greater risk of mortality or distal TEVAR failure within 2 years (34% vs 5%, P = 0.012), as did those with dLZ length less than 4 cm (27% vs 6%, P = 0.006).
CONCLUSIONS: In this study, mild dilation at the dLZ beyond 35 mm and short length at the dLZ less than 4 cm are both clear anatomic risk factors for poor long-term outcome after supraceliac TEVAR. It may be appropriate to consider repair via branched endografts landing beyond the coeliac artery in patients with these risk factors.
METHODS: Consecutive patients undergoing thoracic endovascular aortic repair (TEVAR) for undissected TAA were queried from a single centre from 2004 to 2022. Patient and operative factors were considered as well as detailed anatomic factors at the dLZ assessed by 3D reconstruction of pre-TEVAR imaging. The outcome of interest was the long-term risk of TEVAR failure at the dLZ.
RESULTS: A total of 101 patients undergoing TEVAR repair of TAA were considered, of whom 17 suffered distal TEVAR failure over a median follow-up period of 2.7 years. Two anatomic factors showed outsized influence on long-term outcomes: dLZ diameter and dLZ length (the length of non-dilated aortic tissue above the coeliac artery). Patients who progressed to distal TEVAR failure had larger dLZ diameter (34.2 mm vs 30.7 mm, P = 0.034) and far shorter dLZ length (3.8 cm vs 7.5 cm, P = 0.008). Patients with dLZ diameter greater than 35 mm had much greater risk of mortality or distal TEVAR failure within 2 years (34% vs 5%, P = 0.012), as did those with dLZ length less than 4 cm (27% vs 6%, P = 0.006).
CONCLUSIONS: In this study, mild dilation at the dLZ beyond 35 mm and short length at the dLZ less than 4 cm are both clear anatomic risk factors for poor long-term outcome after supraceliac TEVAR. It may be appropriate to consider repair via branched endografts landing beyond the coeliac artery in patients with these risk factors.