P-066 - SEVERE TORTUOSITY OF THE DISTAL DESCENDING THORACIC AORTA AFFECTS THE ACCURACY OF DISTAL DEPLOYMENT DURING A THORACIC ENDOVASCULAR AORTIC REPAIR

TOPIC:
Thoraco-abdominal Aortic Disease
AUTHORS:
Sato T. (Nagoya University Graduate School of Medicine ~ Nagoya ~ Japan) , Kawai Y. (Nagoya University Graduate School of Medicine ~ Nagoya ~ Japan) , Sugimoto M. (Nagoya University Graduate School of Medicine ~ Nagoya ~ Japan) , Niimi K. (Nagoya University Graduate School of Medicine ~ Nagoya ~ Japan) , Kodama A. (Nagoya University Graduate School of Medicine ~ Nagoya ~ Japan) , Banno H. (Nagoya University Graduate School of Medicine ~ Nagoya ~ Japan) , Komori K. (Nagoya University Graduate School of Medicine ~ Nagoya ~ Japan)
Introduction:
An accurate distal deployment is essential for successful thoracic endovascular aortic repair (TEVAR) for a para-diaphragmatic aortic aneurysm. This study aimed to investigate the anatomical and intra-operative factors that affect the accuracy of distal deployment during TEVAR.
Methods:
We conducted a retrospective review of pre and postoperative computed tomography (CT) scans of 426 patients undergoing TEVAR at our institution between October 2008 and May 2021, of which the stent graft was attempted to be deployed just above the celiac axis or the superior mesenteric artery in 56 patients. Based on the anatomical factors related to malposition (deployed > 10 mm away from the target vessel) and the greater curve to the straight line ratio (G/S ratio), the patients were categorised as the severe tortuosity (n = 21) and mild tortuosity (n = 35) groups to compare the operative and clinical outcomes.
Results:
Stent-graft malpositioning occurred in 21 cases.; of all anatomical variables, only the G/S ratio was significantly larger in the malpositioned cases (p = 0.049). A cut-off G/S ratio value of 1.15 was determined using receiver operand curve analysis. In the severe tortuosity group, the distal end of the stent graft was significantly farther (median: 10.0 (IQR: 2.5-19.5) mm vs 3.0 (0-8.0) mm; p = 0.015) from the target vessel, and the tilt angle of the stent graft's distal edge was larger (median: 21.4 (IQR: 15.8-24.5) vs 9.5 (5.5-12.5) degree; p<.01) than the mild tortuosity group. Both groups were comparable for the incidence of primary type Ib endoleak (p = 0.454), secondary type Ib endoleak (p = 1.0), and the rate of distal re-intervention (p = 0.276).
Conclusion:
Severe tortuosity in the distal descending thoracic aorta is associated with a malpositioned and tilted distal end of the stent graft. Although this anatomical complexity did not affect the clinical outcomes after TEVAR, it warrants more caution to ensure a distal deployment.
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