Type 1a endoleak following Zone 1 and Zone 2 thoracic endovascular aortic repair: effect of bird-beak configuration†

Kudo, Teruo; Kuratani, Toru; Shimamura, Kazuo; Sakamoto, Tomohiko; Kin, Keiwa; Masada, Kazuhiro; Shijo, Takayuki; Torikai, Kei; Maeda, Koichi; Sawa, Yoshiki

doi:10.1093/ejcts/ezx254

Cited by 39 publications

(30 citation statements)

References 22 publications

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“…No study reported a threshold value for the α angle, which varied between 6.12° and 51°. Five studies 1,[16][17][18]28 reported a threshold value for PLS: 5 mm in 4 articles 1,16,18,28 and 3 mm in 1 article. 17 The PLS length varied between 3 and 29 mm.…”

Section: Resultsmentioning

confidence: 99%

“…Among anatomical features, 7 articles [16][17][18][19]24,25,28 reported severe arch angulation as a risk factor for the BBC, but no consistent definition for angulation was used. Proximal landing zones 2 and 3 were also found to be associated with an increased risk of the BBC.…”

Section: Resultsmentioning

confidence: 99%

“…Also, no proven and shared values for the grading of these features are available. In our review, a threshold value for the α angle was not suggested in any article, and only 5 clinical studies 1,[16][17][18]28 and 1 experimental work 39 reported a threshold value for the PLS. No further studies, however, were performed to validate these findings.…”

Section: Discussionmentioning

confidence: 96%

“…The time between the index TEVAR and the occurrence of the complication related to the BBC ranged between 0 and 72 months. 26,29 Twelve studies [1][2][3]14,15,[17][18][19][20]22,25,29 reported detailed information to analyze the impact of the BBC on postoperative outcome and were included in the quantitative analysis. Complications occurred in 14.7% (95% CI 7.4% to 27.3%) of patients with BBC and in 6.3% (95% CI 2.5% to 15.4%) of patients without BBC (Table 2).…”

Section: Qualitative Analysismentioning

confidence: 99%

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Impact of the Bird-Beak Configuration on Postoperative Outcome After Thoracic Endovascular Aortic Repair: A Meta-analysis

et al. 2019

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Purpose: To investigate the association between the bird-beak configuration (BBC), a wedge-shaped gap between the undersurface of a thoracic endograft and the lesser curvature of the arch after thoracic endovascular aortic repair (TEVAR), and postoperative outcome after TEVAR. Methods: The study was performed according to the PRISMA guidelines. The PubMed, EMBASE, and Cochrane databases were searched to identify all case series reporting BBC after TEVAR between 2006 and April 2018. Data analysis was performed considering the difference in the risk of complications for presence vs absence of BBC. After screening 1633 articles, 21 studies were identified that matched the selection criteria; 12 of these reported detailed information to investigate the postoperative outcome using proportion meta-analysis with a random effects model. The pooled risk difference is reported with the 95% confidence interval (CI). Heterogeneity of the included studies was assessed with the I2 statistic (low 25%, medium 50%, high 75%). Results: Complications occurred within a range of 0 to 72 months in 14.7% (95% CI 7.4% to 27.3%) of patients with BBC and in 6.3% (95% CI 2.5% to 15.4%) of patients without BBC. A cumulative incidence could not be assessed. The summary risk difference was 11.1% (95% CI −0.1% to 22.3%, p=0.052). There was significant heterogeneity ( I2=85.6%). The Egger test did not show evidence of publication bias (p=0.975). When specifically considering type Ia endoleak and endograft migration, the risk difference between BBC and non-BBC patients was 8.2% (95% CI 0.3% to 16.1%, p=0.042; I2=69.0%). The specific risk difference for endograft collapse/infolding and thrombosis was 3.7% (95% CI −3.5% to 11.1%, p=0.308; I2=10.2%). Conclusion: At present the literature does not provide statistical evidence to establish an overall prognostic value of the BBC. Nevertheless, the BBC appears to be associated with a high risk of type Ia endoleak and endograft migration, which warrants specific and long-term surveillance. Clinically relevant values for BBC grading should be established to perhaps define indications for preemptive treatment based on the presence of BBC only.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

Section: Qualitative Analysismentioning

confidence: 99%

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Impact of the Bird-Beak Configuration on Postoperative Outcome After Thoracic Endovascular Aortic Repair: A Meta-analysis

et al. 2019

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“…Several explanations of RTAD caused by excessive oversizing have been discussed in the previous literature, 9‐11 and it has been reported that the stent radial oversizing ratio (OSR) is a key factor affecting the success of TEVAR. Experience from the clinical outcomes is that the proximal landing zone OSR is generally no more than 15%; at present, domestic and foreign experts agree that the stent OSR is recommended to be 0% to 15% 12‐14 …”

Section: Introductionmentioning

confidence: 99%

Numerical modeling and simulations of type B aortic dissection treated by stent‐grafts with different oversizing ratios

Meng

Cai

et al. 2020

Artificial Organs

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Retrograde type A dissection after thoracic endovascular aortic repair has been a major drawback of endovascular treatment. This study investigated the biomechanical mechanism of stent‐graft‐induced new lesions after implantation and analyzed the relationship between radial force and spring‐back force of the stent‐graft when it was implanted virtually under different oversizing ratios. Based on the computed tomography angiography images, a three‐dimensional geometric model of a patient‐specific aortic dissection was established. The stent was designed in CAD software and the stent‐graft implantation procedure under different oversizing ratios was simulated in the finite element analysis software. Implantation simulations were performed six times for each stent‐graft model under 0%, 3%, 6%, 9%, 12%, and 15% oversizing ratios and the peak stress of the aorta was compared among groups. It was observed that the peak stress of the aorta was located where the proximal bare stent interacted with aortic wall and its value was increased by 62.2% from 0% to 15% oversizing ratio. The conclusions are reached that the long‐term higher stress in the aortic wall may lead to the emergence of new lesions in these areas, and the radial force plays a key role in the formation of a new entry in the real aorta model.

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Repair of Type Ia Endoleaks Involving the Distal Arch Using Left Subclavian Artery–Left Common Carotid Artery Transposition with a Stented Elephant Trunk

Zhu

et al. 2020

Annals of Vascular Surgery

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Type 1a endoleak following Zone 1 and Zone 2 thoracic endovascular aortic repair: effect of bird-beak configuration†

Cited by 39 publications

References 22 publications

Impact of the Bird-Beak Configuration on Postoperative Outcome After Thoracic Endovascular Aortic Repair: A Meta-analysis

Impact of the Bird-Beak Configuration on Postoperative Outcome After Thoracic Endovascular Aortic Repair: A Meta-analysis

Numerical modeling and simulations of type B aortic dissection treated by stent‐grafts with different oversizing ratios

Repair of Type Ia Endoleaks Involving the Distal Arch Using Left Subclavian Artery–Left Common Carotid Artery Transposition with a Stented Elephant Trunk

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