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Thoracic endovascular aortic repair migration and aortic elongation differentiated using dual reference point analysis.
J Vasc Surg. 2018 02; 67(2):382-388.JV

Abstract

OBJECTIVE

We evaluated images of patients undergoing a thoracic endovascular aortic repair procedure using two reference points as a means for differentiating stent graft migration from aortic elongation. Conventional standards define migration of a stent graft as an absolute change in the distance from the distal graft ring to a distal landmark ≥10 mm compared with a baseline measurement. Aortic elongation occurs over time in both healthy individuals and patients with aortic disease. Aortic elongation in patients with stent grafts may result in increased distal thoracic aortic lengths over time. False-positive stent graft migration would be defined when these patients meet the standard definition for migration, even if the stent has not moved in relation to the elongating aorta.

METHODS

This retrospective study evaluated the aortic length of 23 patients treated with the conformable GORE TAG thoracic endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz) in three clinical trials (dissection, traumatic injury, and aneurysm). Patients who met the standard definition for migration were selected. A standardized protocol was used to measure aortic centerline lengths, including the innominate artery (IA) to the most distal device ring, the IA to the celiac artery (CA), and the distal ring to the CA. Baseline lengths obtained from the first postoperative image were compared with length measurements obtained from the first interval at which they met the standard definition for migration. The conventional standards for migration using a single reference point were compared with the use of dual reference points.

RESULTS

Of the 23 patients with endograft changes, 20 were deemed to have aortic elongation rather than true migration. The remaining three patients were deemed to have migration on the basis of the IA to distal ring position compared with the IA to CA length change. The IA to CA interval length change was markedly greater in those with elongation compared with migration (23.8 ± 8.4 mm vs -3.5 ± 5.4 mm, respectively; P < .05). The distal ring to CA interval length change was greater in patients showing elongation rather than migration (18.5 ± 6.6 mm vs -9.8 ± 5.4 mm, respectively; P < .05). The distance between the IA and distal ring was similar for elongation and migration.

CONCLUSIONS

These results highlight the dynamic changes that can occur in the aorta as a natural consequence of age. Employing two landmarks can account for these changes and proves to be an important factor, among others, in the differentiation of aortic elongation from true stent graft migration.

Authors+Show Affiliations

Division of Vascular Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisc. Electronic address: albertah@gmail.com.Division of Vascular Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisc.Division of Vascular Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisc.Division of Vascular Surgery and Endovascular Surgery, Harvard Medical School, Boston, Mass.Division of Vascular Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, Ga.Division of Vascular Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisc.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28943007

Citation

Alberta, Hillary B., et al. "Thoracic Endovascular Aortic Repair Migration and Aortic Elongation Differentiated Using Dual Reference Point Analysis." Journal of Vascular Surgery, vol. 67, no. 2, 2018, pp. 382-388.
Alberta HB, Takayama T, Panthofer A, et al. Thoracic endovascular aortic repair migration and aortic elongation differentiated using dual reference point analysis. J Vasc Surg. 2018;67(2):382-388.
Alberta, H. B., Takayama, T., Panthofer, A., Cambria, R. P., Farber, M. A., Jordan, W. D., & Matsumura, J. S. (2018). Thoracic endovascular aortic repair migration and aortic elongation differentiated using dual reference point analysis. Journal of Vascular Surgery, 67(2), 382-388. https://doi.org/10.1016/j.jvs.2017.07.108
Alberta HB, et al. Thoracic Endovascular Aortic Repair Migration and Aortic Elongation Differentiated Using Dual Reference Point Analysis. J Vasc Surg. 2018;67(2):382-388. PubMed PMID: 28943007.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thoracic endovascular aortic repair migration and aortic elongation differentiated using dual reference point analysis. AU - Alberta,Hillary B, AU - Takayama,Toshio, AU - Panthofer,Annalise, AU - Cambria,Richard P, AU - Farber,Mark A, AU - Jordan,William D, AU - Matsumura,Jon S, Y1 - 2017/09/21/ PY - 2017/02/03/received PY - 2017/07/07/accepted PY - 2017/9/26/pubmed PY - 2018/6/26/medline PY - 2017/9/26/entrez SP - 382 EP - 388 JF - Journal of vascular surgery JO - J Vasc Surg VL - 67 IS - 2 N2 - OBJECTIVE: We evaluated images of patients undergoing a thoracic endovascular aortic repair procedure using two reference points as a means for differentiating stent graft migration from aortic elongation. Conventional standards define migration of a stent graft as an absolute change in the distance from the distal graft ring to a distal landmark ≥10 mm compared with a baseline measurement. Aortic elongation occurs over time in both healthy individuals and patients with aortic disease. Aortic elongation in patients with stent grafts may result in increased distal thoracic aortic lengths over time. False-positive stent graft migration would be defined when these patients meet the standard definition for migration, even if the stent has not moved in relation to the elongating aorta. METHODS: This retrospective study evaluated the aortic length of 23 patients treated with the conformable GORE TAG thoracic endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz) in three clinical trials (dissection, traumatic injury, and aneurysm). Patients who met the standard definition for migration were selected. A standardized protocol was used to measure aortic centerline lengths, including the innominate artery (IA) to the most distal device ring, the IA to the celiac artery (CA), and the distal ring to the CA. Baseline lengths obtained from the first postoperative image were compared with length measurements obtained from the first interval at which they met the standard definition for migration. The conventional standards for migration using a single reference point were compared with the use of dual reference points. RESULTS: Of the 23 patients with endograft changes, 20 were deemed to have aortic elongation rather than true migration. The remaining three patients were deemed to have migration on the basis of the IA to distal ring position compared with the IA to CA length change. The IA to CA interval length change was markedly greater in those with elongation compared with migration (23.8 ± 8.4 mm vs -3.5 ± 5.4 mm, respectively; P < .05). The distal ring to CA interval length change was greater in patients showing elongation rather than migration (18.5 ± 6.6 mm vs -9.8 ± 5.4 mm, respectively; P < .05). The distance between the IA and distal ring was similar for elongation and migration. CONCLUSIONS: These results highlight the dynamic changes that can occur in the aorta as a natural consequence of age. Employing two landmarks can account for these changes and proves to be an important factor, among others, in the differentiation of aortic elongation from true stent graft migration. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/28943007/Thoracic_endovascular_aortic_repair_migration_and_aortic_elongation_differentiated_using_dual_reference_point_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(17)31934-1 DB - PRIME DP - Unbound Medicine ER -