Massimiliano M Marrocco-Trischitta1, Hector W de Beaufort2, Francesco Secchi3, Theodorus M van Bakel2, Marco Ranucci4, Joost A van Herwaarden5, Frans L Moll5, Santi Trimarchi6. 1. Division of Vascular Surgery II, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy; Thoracic Aortic Research Center, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy. Electronic address: massimiliano.marroccotrischitta@grupposandonato.it. 2. Thoracic Aortic Research Center, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy. 3. Division of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy. 4. Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy. 5. Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 6. Division of Vascular Surgery II, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy; Thoracic Aortic Research Center, Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, San Donato Milanese, Italy.
Abstract
OBJECTIVE: This study assessed whether the additional use of the aortic arch classification in type I, II, and III may complement Ishimaru's aortic arch map and provide valuable information on the geometry and suitability of proximal landing zones for thoracic endovascular aortic repair. METHODS: Anonymized thoracic computed tomography scans of healthy aortas were reviewed and stratified according to the aortic arch classification, and 20 of each type of arch were selected. Further processing allowed calculation of angulation and tortuosity of each proximal landing zone. Data were described indicating both proximal landing zone and type of arch (eg, 0/I). RESULTS: Angulation was severe (>60°) in 2/III and in 3/III. Comparisons among the types of arch showed an increase in proximal landing zones angulation (P < .001) and tortuosity (P = .009) depending on the type of arch. Comparisons within type of arch showed no change in angulation and tortuosity across proximal landing zones within type I arch (P = .349 and P = .409), and increases in angulation and tortuosity toward more distal proximal landing zones within type II (P = .003 and P = .043) and type III (P < .001 in both). CONCLUSIONS: The aortic arch classification is associated with a consistent geometric pattern of the aortic arch map, which identifies specific proximal landing zones with suboptimal angulation for stent graft deployment. Arches II and III also appear to have progressively less favorable anatomy for thoracic endovascular aortic repair compared with arch I.
OBJECTIVE: This study assessed whether the additional use of the aortic arch classification in type I, II, and III may complement Ishimaru's aortic arch map and provide valuable information on the geometry and suitability of proximal landing zones for thoracic endovascular aortic repair. METHODS: Anonymized thoracic computed tomography scans of healthy aortas were reviewed and stratified according to the aortic arch classification, and 20 of each type of arch were selected. Further processing allowed calculation of angulation and tortuosity of each proximal landing zone. Data were described indicating both proximal landing zone and type of arch (eg, 0/I). RESULTS: Angulation was severe (>60°) in 2/III and in 3/III. Comparisons among the types of arch showed an increase in proximal landing zones angulation (P < .001) and tortuosity (P = .009) depending on the type of arch. Comparisons within type of arch showed no change in angulation and tortuosity across proximal landing zones within type I arch (P = .349 and P = .409), and increases in angulation and tortuosity toward more distal proximal landing zones within type II (P = .003 and P = .043) and type III (P < .001 in both). CONCLUSIONS: The aortic arch classification is associated with a consistent geometric pattern of the aortic arch map, which identifies specific proximal landing zones with suboptimal angulation for stent graft deployment. Arches II and III also appear to have progressively less favorable anatomy for thoracic endovascular aortic repair compared with arch I.
Authors: Viony M Belvroy; Hector W L de Beaufort; Joost A van Herwaarden; Jean Bismuth; Gabriele Piffaretti; Frans L Moll; Santi Trimarchi Journal: World J Surg Date: 2020-04 Impact factor: 3.352
Authors: Theodorus M van Bakel; Hector W de Beaufort; Santi Trimarchi; Massimiliano M Marrocco-Trischitta; Jean Bismuth; Frans L Moll; Himanshu J Patel; Joost A van Herwaarden Journal: Ann Cardiothorac Surg Date: 2018-05