Comparison of intravascular ultrasound- and centerline computed tomography-determined aortic diameters during thoracic endovascular aortic repair

Han, Sukgu M.; Elsayed, Ramsey S.; Ham, Sung W.; Mahajan, Anuj; Fleischman, Fernando; Rowe, Vincent L.; Cunningham, Mark J.

doi:10.1016/j.jvs.2017.03.445

Cited by 19 publications

(8 citation statements)

References 21 publications

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“…Concern has been expressed that centerline CT measurement underestimates aortic size. [11][12][13][14] This has been our experience as well (J. Elefteriades, MD, unpublished data, April 2018). Both the literature and our as-yet unpublished studies have suggested that the centerline method under-reads diameter, compared with the traditional manual methods, by at least 3 to 4 mm.…”

Section: Advent Of Automated ''Centerline'' Imaging Measurementmentioning

confidence: 92%

Descending threshold for ascending aortic aneurysmectomy: Is it time for a “left-shift” in guidelines?

Ziganshin

Zafar

Elefteriades

2019

The Journal of Thoracic and Cardiovascular Surgery

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Current guidelines on the management of thoracic aortic disease recommend that the ascending aorta be replaced when it reaches the size of 5.5 cm. Recently emerging data suggest that this criterion may need to be shifted to the left, signifying a recommendation to operate on patients with smaller aortic sizes. The data that support the need for a leftward shift in the guidelines include (1) novel and more granular data on the natural history of ascending aortic aneurysm between 5 and 6 cm showing that 2 hinge risk points exist-one at 5.25 cm, and the other at 5.75 cm; (2) aortic diameter before the moment of aortic dissection is at least 7 mm smaller than postdissection aortic size; (3) the advent of a semiautomated centerline method of imaging assessment seems to underestimate true ascending aortic size; (4) aortic surgery in the present era is very safe and its benefits outweigh the associated risks; (5) genetic testing via high-throughput next-generation sequencing identifies genetic defects responsible for aortic catastrophes at smaller aortic sizes; and (6) familial aortic dissection occurrence suggests that family members of an aortic dissection victim who harbor a sizable aneurysm should be operated on regardless of aortic size.

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Section: Advent Of Automated ''Centerline'' Imaging Measurementmentioning

confidence: 92%

Descending threshold for ascending aortic aneurysmectomy: Is it time for a “left-shift” in guidelines?

Ziganshin

Zafar

Elefteriades

2019

The Journal of Thoracic and Cardiovascular Surgery

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“…However, intravascular ultrasound may be a promising alternative for real-time visualization of the aortic anatomy. 10 Third, compared with endovascular repair over a single peripheral approach, the combined approach requires a minithoracotomy, increasing surgical burden for the patient.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of the ascending aorta using a combined transapical and transfemoral approach

Grieshaber

Nink

Roth

et al. 2018

Journal of Vascular Surgery

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In high-risk patients with diseases of the ascending aorta, endovascular repair might be a therapeutic alternative to surgical repair. We developed a combined access route with transapical and transfemoral externalization of the wire and report the operative technique as well as our initial experience of six patients treated with this method. Improved wire control resulted in precise deployment of endovascular prostheses, respecting the integrity of the coronary ostia and the supra-aortic vessels. Procedural success was 100%, and follow-up until 32 months postoperatively showed no need for reintervention or mortality. However, long-term results of the presented technique are still unknown.

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“…At the time of intervention, patients are likely to have received adequate volume resuscitation with resultant normalization of the aortic diameter. Utilization of IVUS during TEVAR allows for more accurate measurement of the aortic diameter, identification of the aortic defect and potential endograft landing zones, and appropriately sized endograft selection (37)(38)(39)(40). Sonographic findings are similar to direct CT findings including vessel wall disruption, intimal flap, pseudoaneurysm, intramural and periaortic hematoma, and complete transection (41,42).…”

Section: Conventional Angiography Intravascular Ultrasound (Ivus) and Transesophageal Echocardiogrammentioning

confidence: 96%

Acute traumatic injury of the aorta: presentation, diagnosis, and treatment

Brown¹,

Still²,

Eudailey³

et al. 2021

Ann Transl Med

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Despite advances in detection and treatment, acute traumatic aortic injury (ATAI) is associated with high rates of morbidity and mortality. Both physical and hemodynamic forces have been postulated as mechanisms of aortic injury during a traumatic event. For patients who survive the initial injury, rapid detection is critical for diagnosis and procedural planning, which requires a thorough knowledge of both its clinical presentation and the available diagnostic imaging modalities. Radiography, computed tomography (CT), and magnetic resonance imaging (MRI) can each have a role in the diagnosis of ATAI.After stabilization of the patient, the management of ATAI is guided by the severity of injury. Appropriately selected patients with low grade injuries may be managed non-operatively. When treatment is required, there are both open surgical and endovascular options. In current practice, endovascular approaches with stentgraft placement are preferred due to their high clinical success and low rates of complications. Complications from endograft placement can include: endoleak, endograft collapse, infection, endograft failure, and endograft migration. Open surgical repair is now reserved for patients with unfavorable anatomy for endovascular therapies. This review provides a comprehensive overview of ATAI including its epidemiology and demographics, mechanisms of injury, clinical and radiographic diagnosis, treatment options, and posttherapeutic follow-up.

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Comparison of intravascular ultrasound- and centerline computed tomography-determined aortic diameters during thoracic endovascular aortic repair

Abstract: IVUS imaging and centerline CTA may provide significantly different aortic diameter measurements, particularly in angulated aortic segments. Caution must be taken when sizing a stent graft using CTA alone, particularly in an angulated proximal landing zone.

Cited by 19 publications

References 21 publications

Descending threshold for ascending aortic aneurysmectomy: Is it time for a “left-shift” in guidelines?

Descending threshold for ascending aortic aneurysmectomy: Is it time for a “left-shift” in guidelines?

Endovascular treatment of the ascending aorta using a combined transapical and transfemoral approach

Acute traumatic injury of the aorta: presentation, diagnosis, and treatment

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