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Aortic Arch Morphology and Aortic Length in Patients with Dissection, Traumatic, and Aneurysmal Disease.
Eur J Vasc Endovasc Surg. 2015 Dec; 50(6):754-60.EJ

Abstract

OBJECTIVES

To assess aortic arch morphology and aortic length in patients with dissection, traumatic injury, and aneurysm undergoing TEVAR, and to identify characteristics specific to different pathologies.

METHOD

This was a retrospective analysis of the aortic arch morphology and aortic length of dissection, traumatic injury, and aneurysmal patients. Computed tomography imaging was evaluated of 210 patients (49 dissection, 99 traumatic injury, 62 aneurysm) enrolled in three trials that received the conformable GORE TAG thoracic endoprosthesis. The mean age of trauma patients was 43 ± 19.6 years, 57 ± 11.7 years for dissection and 72 ± 9.6 years for aneurysm patients. A standardized protocol was used to measure aortic arch diameter, length, and take-off angle and clockface orientation of branch vessels. Differences in arch anatomy and length were assessed using ANOVA and independent t tests.

RESULTS

Of the 210 arches evaluated, 22% had arch vessel common trunk configurations. The aortic diameter and the distance from the left main coronary (LMC) to the left common carotid (LCC) were greater in dissection patients than in trauma or aneurysm patients (p < .001). Aortic diameter in aneurysm patients was greater compared with trauma patients (p < .05). The distances from the branch vessels to the celiac artery (CA) were greater in dissection and aneurysm patients than in trauma patients (p < .001). The take-off angle of the innominate (I), LCCA, and left subclavian (LS) were greater, between 19% and 36%, in trauma patients than in dissection and aneurysm patients (p < .001). Clockface orientation of the arch vessels varies between pathologies.

CONCLUSIONS

Arch anatomy has significant morphologic differences when comparing aortic pathologies. Describing these differences in a large sample of patients is beneficial for device designs and patient selection.

Authors+Show Affiliations

School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, WI, USA. Electronic address: alberta@surgery.wisc.edu.School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, WI, USA.School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, WI, USA.School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, WI, USA; W. L. Gore & Associates, Flagstaff, AZ, USA.Division of Vascular Surgery and Endovascular Surgery, Harvard Medical School, Boston, Massachusetts, USA.Division of Vascular Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL, USA.Division of Vascular Surgery and Endovascular Surgery, Harvard Medical School, Boston, Massachusetts, USA.Department of Cardiothoracic & Vascular Surgery, University of Texas Houston Medical School, Houston, TX, USA.Morton Plant Hospital Valve and Structural Heart Center, Clearwater, FL, USA.School of Medicine and Public Health, Division of Vascular Surgery, University of Wisconsin, Madison, WI, USA.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26371414

Citation

Alberta, H B., et al. "Aortic Arch Morphology and Aortic Length in Patients With Dissection, Traumatic, and Aneurysmal Disease." European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, vol. 50, no. 6, 2015, pp. 754-60.
Alberta HB, Takayama T, Smits TC, et al. Aortic Arch Morphology and Aortic Length in Patients with Dissection, Traumatic, and Aneurysmal Disease. Eur J Vasc Endovasc Surg. 2015;50(6):754-60.
Alberta, H. B., Takayama, T., Smits, T. C., Wendorff, B. B., Cambria, R. P., Farber, M. A., Jordan, W. D., Patel, V., Azizzadeh, A., Rovin, J. D., & Matsumura, J. S. (2015). Aortic Arch Morphology and Aortic Length in Patients with Dissection, Traumatic, and Aneurysmal Disease. European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, 50(6), 754-60. https://doi.org/10.1016/j.ejvs.2015.08.005
Alberta HB, et al. Aortic Arch Morphology and Aortic Length in Patients With Dissection, Traumatic, and Aneurysmal Disease. Eur J Vasc Endovasc Surg. 2015;50(6):754-60. PubMed PMID: 26371414.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aortic Arch Morphology and Aortic Length in Patients with Dissection, Traumatic, and Aneurysmal Disease. AU - Alberta,H B, AU - Takayama,T, AU - Smits,T C, AU - Wendorff,B B, AU - Cambria,R P, AU - Farber,M A, AU - Jordan,W D, AU - Patel,V, AU - Azizzadeh,A, AU - Rovin,J D, AU - Matsumura,J S, Y1 - 2015/09/11/ PY - 2015/02/11/received PY - 2015/08/10/accepted PY - 2015/9/16/entrez PY - 2015/9/16/pubmed PY - 2016/4/19/medline KW - Aneurysm KW - Aortic arch KW - Aortic length KW - Aortic morphology KW - Dissection KW - Traumatic injury SP - 754 EP - 60 JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JO - Eur J Vasc Endovasc Surg VL - 50 IS - 6 N2 - OBJECTIVES: To assess aortic arch morphology and aortic length in patients with dissection, traumatic injury, and aneurysm undergoing TEVAR, and to identify characteristics specific to different pathologies. METHOD: This was a retrospective analysis of the aortic arch morphology and aortic length of dissection, traumatic injury, and aneurysmal patients. Computed tomography imaging was evaluated of 210 patients (49 dissection, 99 traumatic injury, 62 aneurysm) enrolled in three trials that received the conformable GORE TAG thoracic endoprosthesis. The mean age of trauma patients was 43 ± 19.6 years, 57 ± 11.7 years for dissection and 72 ± 9.6 years for aneurysm patients. A standardized protocol was used to measure aortic arch diameter, length, and take-off angle and clockface orientation of branch vessels. Differences in arch anatomy and length were assessed using ANOVA and independent t tests. RESULTS: Of the 210 arches evaluated, 22% had arch vessel common trunk configurations. The aortic diameter and the distance from the left main coronary (LMC) to the left common carotid (LCC) were greater in dissection patients than in trauma or aneurysm patients (p < .001). Aortic diameter in aneurysm patients was greater compared with trauma patients (p < .05). The distances from the branch vessels to the celiac artery (CA) were greater in dissection and aneurysm patients than in trauma patients (p < .001). The take-off angle of the innominate (I), LCCA, and left subclavian (LS) were greater, between 19% and 36%, in trauma patients than in dissection and aneurysm patients (p < .001). Clockface orientation of the arch vessels varies between pathologies. CONCLUSIONS: Arch anatomy has significant morphologic differences when comparing aortic pathologies. Describing these differences in a large sample of patients is beneficial for device designs and patient selection. SN - 1532-2165 UR - https://www.unboundmedicine.com/medline/citation/26371414/Aortic_Arch_Morphology_and_Aortic_Length_in_Patients_with_Dissection_Traumatic_and_Aneurysmal_Disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1078-5884(15)00609-7 DB - PRIME DP - Unbound Medicine ER -