Modelling of predissection aortic size in acute descending aortic dissection.

OBJECTIVES: Large aortic diameter is considered the most frequent cause of aortic dissection. However, this assumption relies on postdissection imaging of the aorta. We recently showed that acute dissection leads to a 23% increase in the descending aortic diameter. Our aim was to model the diameter of the aorta before the acute descending aortic dissection occurred. METHODS: Between 2003 and 2017, a total of 190 patients developed acute descending aortic dissection. In total, 165 non-Marfan patients were included, whose computed tomography angiography scans were available and taken within 6 h after the occurrence of acute descending aortic dissection [67 (first quartile 58-third quartile 75) years, 69% males]. The maximum postdissection aortic diameter was measured at the level of the mid-descending aorta. Modelling was performed by dividing the postdissection aortic diameter by the factor 1.23. RESULTS: The median modelled predissection descending diameter measured in the mid-descending aorta was 30.5 (27.3-35.4) mm. The median predissection descending diameter was higher in men (P = 0.021) and associated with age (P < 0.001) but not with body surface area. The modelled diameter of the predissected descending aorta revealed that 98.8% (163/165) of patients had an aortic diameter measuring <55 mm and 84.8% (140/165) <40 mm. In other words, 50% of these patients had a non-dilated descending aorta prior to dissection onset. CONCLUSIONS: Modelling indicated that more than 80% of patients who suffered an acute descending aortic dissection had a descending aorta <40 mm before dissection onset. Only 1% of them would have met the guideline criteria (aortic diameter ≥55 mm) for elective descending aortic repair. The role of an excessively large aortic diameter as a predictor of descending aortic dissection might be overrated.

Accuracy of deployment of the Relay non-bare stent graft in the aortic arch.

OBJECTIVES: To minimize the complications with thoracic endovascular aortic repair (TEVAR), a new stent graft with no bare ends was developed, namely the Relay non-bare stent (NBS). We hypothesized that the new features of the NBS graft would enable highly accurate deployment and fewer complications. The aim of this study was to analyse the quality of the Relay NBS with respect to its landing precision. METHODS: Relying on computed tomography angiographs, we evaluated the distance between the stent graft and the target vessel in the proximal landing zone (before and after the intervention as well as the mid-term results). Seventy-eight patients with thoracic aortic pathologies were included. Median computed tomography angiograph follow-up was 16 months. RESULTS: The stent graft was deployable ≤5 mm from the target vessel in 64 (82%) patients; in 14 (18%) of them, the distance to the target vessel was >5 mm. According to the last follow-up computed tomography angiograph, in 35 (55%) patients, the distance to the target vessel was ≤5 mm and in 29 (45%) patients, it was >5 mm. There was no endoleak type Ia immediately after TEVAR or during the follow-up period. A substantial bird beak phenomenon was observed in 3 (4%) and 7 (11%) patients immediately after TEVAR and during the follow-up period, respectively. One patient had a retrograde dissection type A. CONCLUSIONS: The Relay NBS graft can be deployed accurately in the aortic arch in most patients. Retrograde aortic dissection type A seldom occurs after TEVAR using the Relay NBS graft. The distance between the NBS graft and the intended target vessel increases during the follow-up period.