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J Thorac Dis. 2018 Apr;10(4):2100-2107. doi: 10.21037/jtd.2018.03.72.

A simple patient-tailored aortic arch tangential angle measuring method to achieve better clinical results for thoracic endovascular repair of type B aortic dissection.

Wang L1,2,3, Hou K4,5, Xu X1,2, Chen B1,2, Jiang J1,2, Shi Z1,2, Tang X1,2, Guo D1,2, Fu W1,2,3.

Author information

1
Department of Vascular Surgery, Fudan University, Shanghai 200032, China.
2
Institute of Vascular Surgery, Fudan University, Shanghai 200032, China.
3
Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China.
4
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
5
Institute of Radiology, Shanghai Municipal, Shanghai 200032, China.

Abstract

Background:

To report a simple individual tailored aortic arch tangential angle (θ-AATA) measuring method and its clinical application efficacy in the endovascular treatment of type B aortic dissection (AD).

Methods:

From January 2013 to December 2014, acute type B AD patients were prospectively enrolled and treated with endovascular therapy in our center. Among these patients, a specific method was applied to measure θ-AATA based on the axial images of the CT scan. The length of proximal landing zone (PLZ) of each patient was measured at the routinely applied left-anterior oblique (LAO) 45-degree and θ-AATA. Respective treatment strategies based on the length of the PLZ were planned accordingly, and the stent-graft was deployed under the fluoroscopy at θ-AATA. The occurrence of immediate type I endoleak was recorded during the completion angiogram, while the alignment of the proximal marks was determined under fluoroscopy at θ-AATA and at LAO-45-degree as well.

Results:

Totally 76 patients with type B AD were prospectively enrolled. The average value of θ-AATA was 58.3±5.2 degrees, which was significantly larger than the routine 45 degrees (P<0.01). The mean landing zone length measured under θ-AATA (18.4±3.9 mm) was longer than that (15.9±3.1 mm) obtained at the routine LAO-45 degrees (P<0.05). Stent-grafts' deployment strategies were substantially changed accordingly. Alignment of the proximal marks was achieved in 72 patients (93.4%) under θ-AATA and only in two patients (2.7%) at LAO-45 degrees (P<0.01). All stent-grafts' implantation was successfully completed. No major type I endoleak was found in the immediate post-deployment angiography.

Conclusions:

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.

KEYWORDS:

Aortic dissection (AD); aortic arch angle; endoleak; endovascular therapy; endovascular treatment; proximal landing zone (PLZ)

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

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