Rebuttal: Should the distal landing zone be assessed in thoracic endovascular aortic repair?

Thoracic Endovascular Repair of Complicated Penetrating Aortic Ulcer

“…30,31 According to our experience, we are convinced that the potential mechanism for developing a stent-graft-induced new entry includes a combination of aortic wall fragility and exacerbation by 2 main factors related to stent-grafting: the tendency of the semirigid stent-graft to revert to its initial straight form and the fact that oversized stent-grafts lead to excessive radial force. 21,[30][31][32][33] Thus, only stent-grafts without bare springs, hooks, or free flow components should be used in patients with acute aortic syndrome. Moreover, oversizing should be minimized.…”

Validation of intravascular ultrasound for measurement of aortic diameters: Comparison with multi-detector computed tomography

“…Clinicians are most often confronted with difficulties in the exact measurement of aortic diameters in the acute setting of thoracic endovascular aortic repair (TEVAR), particularly in tortuosities and especially that of the aortic arch (6). Here, IVUS can be used as an important intraoperative tool to determine the exact aortic vessel diameter in TEVAR (7,8 of secondary endoleaks, and need for reintervention depend on the exact measurement of landing zones (9)(10)(11)(12), which can be especially difficult in emergency cases where no computed tomography (CT) angiography (CTA) or only CT with poor image quality is available. The objective of the present study was to validate IVUS measurements with CTA measurements in detail in a sufficiently high number of patients, which has not been previously reported.…”