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Morphometric Study of the Normal Aortic Arch and Aneurysmal
Volume 38, January 2017
Abstracts accepted for presentation during the 31st Annual Meeting of the French Society for Vascular and Endovascular Surgery, Grenoble, June 24-27, 2016, President: Pr. Jean-Luc Magne
MORPHOMETRIC STUDY OF THE NORMAL AORTIC ARCH AND ANEURYSMAL Julien Gaudric, Emmanuelle Carre, Fabien Koskas, and Jose-Maria Fullana Service de chirurgie vasculaire, H^opital Pitie-Salp^etriere, and Institut Jean Le Rond d’Alembert, Universite Pierre et Marie Curie, Paris. Objectives: The endovascular treatment of aortic aneurysms is less invasive than the conventional surgical treatment. Nevertheless the conjunction of the aortic curvature and the origin of the supra-aortic trunks (SAT) at the level of the arch require an adaptation of the dedicated material. For that reason the morphological study of the aorta arch is necessary. Materials and Methods: The study was carried out from aortic angio-CTs. Four groups were designed: group 1: normal aorta (n¼20); group 2: aneurysm of the ascending aorta (n¼20); group 3: aneurysm of the posterior arch extending to the descending thoracic aorta (n¼13); group 4: aneurysm of the ascending aorta + aortic arch (n¼20). The diameters of the aorta as well as the lengths of the central line and the external curvature were measured using the Endosize software (Therenva). The orientation of the SATs plane was laid down by the line passing by the ostia of the brachio-cephalic trunk and the LSA. Results: The maximum diameter (Dmax) of the ascending aorta was increased by 130%, 55% and 59% in groups 2, 3 and 4 compared to the normal aorta, respectively. Dmax of the horizontal portion of the arch was increased by 44%, 40% and 44% in groups 2, 3 and 4, respectively. Dmax of the descending thoracic aorta was increased by 4%, 70% and 46% in groups 2, 3 and 4, respectively. The average length of the central line of the thoracic aorta was increased by 15%, 25% and 20% for groups 2, 3 and 4 compared to the normal aorta, respectively. The length of the aorta increased proportionally with the aortic diameter. On average, the external line was increased by 17% compared to the central line in each group. The slope of the axis formed by the origin of the SAT was 0.6 in group 1, 0.3 in group 2, 2.3 in group 3, and 1.2 in group 4. Conclusion: Aneurysms generate a centripetal but also longitudinal extension of the aortic tissues. This expansion creates an anterior angulation in the event of an ascending aortic aneurysm and a posterior angulation in the event of an aneurysm of the descending thoracic aorta. This leads to a flattening of the plane of the SATs when the aneurysm reaches the anterior portion of the arch and verticalize it in the event of posterior development of the aneurysm. Moreover the expansion of the aorta is limited to the aneurysmal segment in case of an aneurysm of the ascending aorta whereas the ascending aorta is also widened in the presence of an aneurysm of the descending thoracic aorta. http://dx.doi.org/10.1016/j.avsg.2016.07.030
e15
ANATOMICAL EVOLUTION OF THE DESCENDING THORACIC AORTA AFTER ENDOVASCULAR TREATMENT OF A DEGENERATIVE ANEURYSM Virgile Omnes, Philippe Amabile, Laurence Bal, Mariangela de Masi, Marine Gaudry, Baptiste David, David Bensoussan, Jean-Michel Bartoli, Michel Bartoli, Pierre-Edouard Magnan, and Philippe Piquet Service de radiologie interventionnelle and Centre de l’aorte, CHU la Timone, Marseille, France. Objectives: The objective of this work was to describe the anatomical evolution of the descending thoracic aorta (DTA) after the endovascular treatment of a degenerative aneurysm (TEVAR) and to study the risk factors of unfavorable evolution. Materials and Methods: This was a retrospective multicentric study comparing the pre- and postoperative scanners of patients treated by TEVAR between September 1997 and July 2015. We compared seven diameters (two for each neck, 15 mm upstream and downstream from the stentgraft and the aneurysmal diameter), four lengths (proximal and distal necks, length of the aneurysm and length of DTA) and four angles (two between the healthy upstream and downstream aorta and two between the necks and the aneurysmal aorta). We made the measurements on the OsiriX software according to the central line. Any increase in the aneurysmal sac of more than 5mm or the presence of a type 1 or 3 endoleak, any reintervention, or a death related to the initial aortic disease defined an unfavorable evolution. Results: We analyzed 61 of the 146 patients treated during this period. Mean age was 74 years. With an average CT follow-up of 27 months, we highlighted a global increase in 2 to 3 mm of the diameter at the level of the proximal and distal necks and 15 mm upstream and downstream from the stentgraft (p<0.005). The aneurysmal diameter decreased by 5 mm on average (p<0.001). We observed a 17 mm lengthening of the descending thoracic aorta (p<0.001). This lengthening was an unfavorable risk factor of evolution and it was mainly related to the lengthening of the initial portion of the DTA (10 mm). We observed a 7 acute evolution of the angle between the proximal neck and the aneurysmal axis (p¼0.009). No patient having a stable length of DTA evolved unfavorably. The unfavorable risk of evolution is all the more high as the aneurysmal disease is diffuse. Conclusion: There exists a remodeling of DTA after endovascular treatment of a degenerative aneurism proportional to the extent of the aneurysmal disease and correlated to an unfavorable anatomical evolution. We observed the appearance of a plication at the level of the proximal portion of DTA. The parietal mechanical
Abstracts accepted for presentation during the 31st Annual Meeting of the French Society for Vascular and Endovascular Surgery, Grenoble, June 24-27, 2016, President: Pr. Jean-Luc Magne
MORPHOMETRIC STUDY OF THE NORMAL AORTIC ARCH AND ANEURYSMAL Julien Gaudric, Emmanuelle Carre, Fabien Koskas, and Jose-Maria Fullana Service de chirurgie vasculaire, H^opital Pitie-Salp^etriere, and Institut Jean Le Rond d’Alembert, Universite Pierre et Marie Curie, Paris. Objectives: The endovascular treatment of aortic aneurysms is less invasive than the conventional surgical treatment. Nevertheless the conjunction of the aortic curvature and the origin of the supra-aortic trunks (SAT) at the level of the arch require an adaptation of the dedicated material. For that reason the morphological study of the aorta arch is necessary. Materials and Methods: The study was carried out from aortic angio-CTs. Four groups were designed: group 1: normal aorta (n¼20); group 2: aneurysm of the ascending aorta (n¼20); group 3: aneurysm of the posterior arch extending to the descending thoracic aorta (n¼13); group 4: aneurysm of the ascending aorta + aortic arch (n¼20). The diameters of the aorta as well as the lengths of the central line and the external curvature were measured using the Endosize software (Therenva). The orientation of the SATs plane was laid down by the line passing by the ostia of the brachio-cephalic trunk and the LSA. Results: The maximum diameter (Dmax) of the ascending aorta was increased by 130%, 55% and 59% in groups 2, 3 and 4 compared to the normal aorta, respectively. Dmax of the horizontal portion of the arch was increased by 44%, 40% and 44% in groups 2, 3 and 4, respectively. Dmax of the descending thoracic aorta was increased by 4%, 70% and 46% in groups 2, 3 and 4, respectively. The average length of the central line of the thoracic aorta was increased by 15%, 25% and 20% for groups 2, 3 and 4 compared to the normal aorta, respectively. The length of the aorta increased proportionally with the aortic diameter. On average, the external line was increased by 17% compared to the central line in each group. The slope of the axis formed by the origin of the SAT was 0.6 in group 1, 0.3 in group 2, 2.3 in group 3, and 1.2 in group 4. Conclusion: Aneurysms generate a centripetal but also longitudinal extension of the aortic tissues. This expansion creates an anterior angulation in the event of an ascending aortic aneurysm and a posterior angulation in the event of an aneurysm of the descending thoracic aorta. This leads to a flattening of the plane of the SATs when the aneurysm reaches the anterior portion of the arch and verticalize it in the event of posterior development of the aneurysm. Moreover the expansion of the aorta is limited to the aneurysmal segment in case of an aneurysm of the ascending aorta whereas the ascending aorta is also widened in the presence of an aneurysm of the descending thoracic aorta. http://dx.doi.org/10.1016/j.avsg.2016.07.030
e15
ANATOMICAL EVOLUTION OF THE DESCENDING THORACIC AORTA AFTER ENDOVASCULAR TREATMENT OF A DEGENERATIVE ANEURYSM Virgile Omnes, Philippe Amabile, Laurence Bal, Mariangela de Masi, Marine Gaudry, Baptiste David, David Bensoussan, Jean-Michel Bartoli, Michel Bartoli, Pierre-Edouard Magnan, and Philippe Piquet Service de radiologie interventionnelle and Centre de l’aorte, CHU la Timone, Marseille, France. Objectives: The objective of this work was to describe the anatomical evolution of the descending thoracic aorta (DTA) after the endovascular treatment of a degenerative aneurysm (TEVAR) and to study the risk factors of unfavorable evolution. Materials and Methods: This was a retrospective multicentric study comparing the pre- and postoperative scanners of patients treated by TEVAR between September 1997 and July 2015. We compared seven diameters (two for each neck, 15 mm upstream and downstream from the stentgraft and the aneurysmal diameter), four lengths (proximal and distal necks, length of the aneurysm and length of DTA) and four angles (two between the healthy upstream and downstream aorta and two between the necks and the aneurysmal aorta). We made the measurements on the OsiriX software according to the central line. Any increase in the aneurysmal sac of more than 5mm or the presence of a type 1 or 3 endoleak, any reintervention, or a death related to the initial aortic disease defined an unfavorable evolution. Results: We analyzed 61 of the 146 patients treated during this period. Mean age was 74 years. With an average CT follow-up of 27 months, we highlighted a global increase in 2 to 3 mm of the diameter at the level of the proximal and distal necks and 15 mm upstream and downstream from the stentgraft (p<0.005). The aneurysmal diameter decreased by 5 mm on average (p<0.001). We observed a 17 mm lengthening of the descending thoracic aorta (p<0.001). This lengthening was an unfavorable risk factor of evolution and it was mainly related to the lengthening of the initial portion of the DTA (10 mm). We observed a 7 acute evolution of the angle between the proximal neck and the aneurysmal axis (p¼0.009). No patient having a stable length of DTA evolved unfavorably. The unfavorable risk of evolution is all the more high as the aneurysmal disease is diffuse. Conclusion: There exists a remodeling of DTA after endovascular treatment of a degenerative aneurism proportional to the extent of the aneurysmal disease and correlated to an unfavorable anatomical evolution. We observed the appearance of a plication at the level of the proximal portion of DTA. The parietal mechanical