OBJECTIVE: Thoracic aneurysm preoperative imaging is performed using static techniques without consideration of normal aortic dynamics. Improved understanding of the native aortic environment into which thoracic endografts are placed may aid in device selection. It is unclear what comprises normal thoracic aortic pulsatility. We studied these phenomena dynamically using ECG-gated 64-slice CTA. METHODS: Maximum diameter and area change per cardiac cycle was measured at surgically relevant anatomic thoracic landmarks in ten patients; 1.0 cm proximal and distal to the subclavian artery, 3.0 cm distal to the subclavian artery, and 3.0 cm proximal to the celiac trunk. Data was acquired using a novel ECG-gated dynamic 64-slice CT scanner during a single breath hold with a standard radiation dose and contrast load. Eight gated data sets, covering the cardiac cycle were reconstructed, perpendicular to the central lumen. RESULTS: There is impressive change in both maximum diameter and area in the thoracic aorta during the cardiac cycle. Mean maximum diameter changes of greater than 10% are observed in the typical sealing zones of commercially available endografts corresponding to diameter increases of up to 5mm. Aortic area increases by over 5% per cardiac cycle. CONCLUSIONS: ECG-gated dynamic CTA with standard radiation dose is feasible on a 64-slice scanner and provides insight into (patho) physiology of thoracic aortic conformational changes. Clinicians typically oversize thoracic endografts by 10%. With aortic pulsatility resulting in diameter changes of up to 17.8%, the potential exists for endograft undersizing, graft migration, intermittent type I endoleak, and poor patient outcome. Furthermore, aortic pulsatility is not evenly distributed, and non-circular stentgraft designs should be considered in the future since aortic distension in the aneurysm neck is not evenly distributed.
OBJECTIVE: Thoracic aneurysm preoperative imaging is performed using static techniques without consideration of normal aortic dynamics. Improved understanding of the native aortic environment into which thoracic endografts are placed may aid in device selection. It is unclear what comprises normal thoracic aortic pulsatility. We studied these phenomena dynamically using ECG-gated 64-slice CTA. METHODS: Maximum diameter and area change per cardiac cycle was measured at surgically relevant anatomic thoracic landmarks in ten patients; 1.0 cm proximal and distal to the subclavian artery, 3.0 cm distal to the subclavian artery, and 3.0 cm proximal to the celiac trunk. Data was acquired using a novel ECG-gated dynamic 64-slice CT scanner during a single breath hold with a standard radiation dose and contrast load. Eight gated data sets, covering the cardiac cycle were reconstructed, perpendicular to the central lumen. RESULTS: There is impressive change in both maximum diameter and area in the thoracic aorta during the cardiac cycle. Mean maximum diameter changes of greater than 10% are observed in the typical sealing zones of commercially available endografts corresponding to diameter increases of up to 5mm. Aortic area increases by over 5% per cardiac cycle. CONCLUSIONS: ECG-gated dynamic CTA with standard radiation dose is feasible on a 64-slice scanner and provides insight into (patho) physiology of thoracic aortic conformational changes. Clinicians typically oversize thoracic endografts by 10%. With aortic pulsatility resulting in diameter changes of up to 17.8%, the potential exists for endograft undersizing, graft migration, intermittent type I endoleak, and poor patient outcome. Furthermore, aortic pulsatility is not evenly distributed, and non-circular stentgraft designs should be considered in the future since aortic distension in the aneurysm neck is not evenly distributed.
Authors: Guido H W van Bogerijen; Jip L Tolenaar; Michele Conti; Ferdinando Auricchio; Francesco Secchi; Francesco Sardanelli; Frans L Moll; Joost A van Herwaarden; Vincenzo Rampoldi; Santi Trimarchi Journal: Aorta (Stamford) Date: 2013-08-01
Authors: Tim F Weber; Maria-Katharina Ganten; Dittmar Böckler; Philipp Geisbüsch; Annette Kopp-Schneider; Hans-Ulrich Kauczor; Hendrik von Tengg-Kobligk Journal: Eur Radiol Date: 2008-07-22 Impact factor: 5.315
Authors: Tim F Weber; Tobias Müller; Andreas Biesdorf; Stefan Wörz; Fabian Rengier; Tobias Heye; Tim Holland-Letz; Karl Rohr; Hans-Ulrich Kauczor; Hendrik von Tengg-Kobligk Journal: Int J Cardiovasc Imaging Date: 2013-10-18 Impact factor: 2.357
Authors: Guido H W van Bogerijen; Joost A van Herwaarden; Michele Conti; Ferdinando Auricchio; Vincenzo Rampoldi; Santi Trimarchi; Frans L Moll Journal: Ann Cardiothorac Surg Date: 2014-05
Authors: Foeke J H Nauta; Guido H W van Bogerijen; Michele Conti; Chiara Trentin; Frans L Moll; Joost A Van Herwaarden; Ferdinando Auricchio; Santi Trimarchi Journal: Aorta (Stamford) Date: 2017-04-01