Abstract:Precise endograft placement in the thoracic aorta is challenging due to the special local anatomy and unique hemodynamic blood flow. We are employing many techniques together to launch the endograft precisely to the target location: various debranching techniques to extend the proximal landing zone, magnified imaging with full exposition of the supra-arch branches and the proximal landing area to achieve a clear and accurate view, screen markers of the landing target for guidance of deployment, 1-2 cm proximal… Show more
“…According to the individual physicians' preference, the measurement of PLZ could be based either on CTA scan or angiography (10). Generally, a LAO-45 degrees' angle was estimated as the common θ-AATA, while our data showed that the exact average value of θ-AATA is 58.3±5.2 degrees, which is apparently larger than the normally applied 45 degrees (5). In this study, we utilized the index of proximal marks' alignment to evaluate the accuracy and efficacy of this angle measuring method.…”
Section: Discussionmentioning
confidence: 65%
“…Three possible reasons may contribute to that why there are still five patients could not obtain alignment even at θ-AATA in this study. The first mechanism is that the aortic arch may be partially deformed or displaced by the deployment of a relatively stiff stent-graft (5). The exact thoracic θ-AATA may be slightly altered accordingly.…”
Section: Discussionmentioning
confidence: 99%
“…The aortic arch tangential angle (θ-AATA) is a crucial anatomical parameter in terms of measuring during TEVAR. Generally, this angle is estimated approximately as 45 left-anterior oblique (LAO) degrees (5). During daily practice, the length of PLZ was measured and documented based on the aortic arch angiography, which was conducted routinely at LAO-45 degrees.…”
It is easy to apply this patient-tailored θ-AATA measuring method in clinical practice. This more precise measurement is benefit for more reasonable treatment strategy planning, more precise deployment, and therefore a better outcome.
“…According to the individual physicians' preference, the measurement of PLZ could be based either on CTA scan or angiography (10). Generally, a LAO-45 degrees' angle was estimated as the common θ-AATA, while our data showed that the exact average value of θ-AATA is 58.3±5.2 degrees, which is apparently larger than the normally applied 45 degrees (5). In this study, we utilized the index of proximal marks' alignment to evaluate the accuracy and efficacy of this angle measuring method.…”
Section: Discussionmentioning
confidence: 65%
“…Three possible reasons may contribute to that why there are still five patients could not obtain alignment even at θ-AATA in this study. The first mechanism is that the aortic arch may be partially deformed or displaced by the deployment of a relatively stiff stent-graft (5). The exact thoracic θ-AATA may be slightly altered accordingly.…”
Section: Discussionmentioning
confidence: 99%
“…The aortic arch tangential angle (θ-AATA) is a crucial anatomical parameter in terms of measuring during TEVAR. Generally, this angle is estimated approximately as 45 left-anterior oblique (LAO) degrees (5). During daily practice, the length of PLZ was measured and documented based on the aortic arch angiography, which was conducted routinely at LAO-45 degrees.…”
It is easy to apply this patient-tailored θ-AATA measuring method in clinical practice. This more precise measurement is benefit for more reasonable treatment strategy planning, more precise deployment, and therefore a better outcome.
“…In the literature many authors 5,6,9 have considered positioning as precise when it is at a mean of 2 AE 2 mm from the predetermined launch site. In these studies deployment accuracy was measured on completion angiogram, while in the present research it was measured on CTA, which allowed greater precision.…”
“…This period of asystole results in a period of calm in the aortic arch that can assist in accurate endograft positioning and deployment. [3][4][5] Contraindications include asthma, second-or thirddegree heart block, and sick sinus syndrome. Atrial flutter is a relative contraindication because of the risk of 1:1 conduction and serious tachycardia.…”
Accurate positioning of thoracic endografts in the aortic arch and the proximal descending thoracic aorta can be difficult because of the tortuous arch anatomy and the hemodynamic forces therein. Adjunctive measures are necessary and include pharmacological interventions as well as rapid ventricular pacing and right-atrial-inflow occlusion. Endograft design advances have also been instrumental in increasing the applicability of this technology to the arch. These adjunctive measures are subsequently described.
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