Risk Factor Analysis for the Mal-Positioning of Thoracic Aortic Stent Grafts

Abstract

TI calculation can be useful to anticipate difficulties during stent graft deployment and to reduce mal-positioning.

The Munich Valsalva Implantation Technique (MuVIT) for Cardiac Output Reduction During TEVAR: Vena Cava Occlusion With the Valsalva Maneuver

“…5 However, complications from pacemaker implantation range from 1% to 6%, and temporary rapid ventricular pacing has been associated with ventricular tachyarrhythmias, atrial and ventricular perforation, and temporary dependence on a pacemaker after the procedure. 2,13…”

“…5 However, complications from pacemaker implantation range from 1% to 6%, and temporary rapid ventricular pacing has been associated with ventricular tachyarrhythmias, atrial and ventricular perforation, and temporary dependence on a pacemaker after the procedure. 2,13 Vena cava occlusion with a compliant balloon has been associated with a mean systolic blood pressure of 49±6 mm Hg lasting 52±14 seconds. Marty et al 7 evaluated its use in 21 patients undergoing TEVAR.…”

“…1 In the acute setting, malpositioning of the proximal edge of the stent-graft can be responsible for early failure and may have potentially fatal consequences, such as unintended coverage of one of the aortic arch branches, or conversely, incomplete exclusion of the aortic lesion, leaving the aneurysm sac persistently pressurized, with sustained risk of rupture. 2 Precise stent-graft placement in the thoracic aorta, especially in the ascending aorta and aortic arch, is particularly challenging due to the special anatomical characteristics and unique hemodynamics in this region. 3,4 Precise deployment of the stent-graft in these areas can be extremely difficult due to pulsation and relevant aortic flow causing to and fro movements; pressure gradients that rise with proximal graft deployment result in a distally oriented push and/or tilt of the stent-graft (windsock effect).…”

<p>Surgical Outcomes And Postoperative Descending Aorta Morphologic Remodeling After Thoracic Endovascular Aortic Repair For Acute And Chronic Type B Aortic Dissection</p>

“…The TI and RoC, which reflect the global anatomy, are other important factors associated with adverse outcomes after TEVAR 26,29,30. Aortic dissections with higher TI values are associated with a stronger spring-back force at the distal end of the stent graft, and this type of force across the tortuous descending aorta fixation site may cause the dissected intima to be potentially vulnerable.…”

Characterization of the Physiological Displacement of the Aortic Arch Using Non-Rigid Registration and MR Imaging

“…1e3 Improvements in endograft design (fenestrated and side-branched) and greater operator experience provide an opportunity to repair the entire aortic arch using endovascular techniques. 1,4 However, there are three challenges for stent-graft delivery to the aortic arch: the anatomical complexity of the aortic arch (curvature, length, angulations, and morphology of the aortic wall) which is the most common cause of early and late endovascular repair failure, 5 the cardiac motion, 6,7 and the respiratory motion which has relatively low influence on the aortic arch compared with the cardiac motion. 6 The cardiac motion was described through different image registration methods.…”