Residual Flow in Covered Area After Elephant Trunk Predicts Unplanned Endovascular Extension
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0286
Submission Type:
Abstract Submission
Authors:
Adam Carroll (1), Rafael Malgor (1), T. Brett Reece (1), Pedro Furtado Neves (1), Muhammad Aftab (1)
Institutions:
(1) University of Colorado Anschutz, Denver, CO
Submitting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Co-Author(s):
Rafael Malgor
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University of Colorado Anschutz
University of Colorado Anschutz
*T. Brett Reece
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University of Colorado Anschutz
University of Colorado Anschutz
Pedro Furtado Neves
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University of Colorado Anschutz
University of Colorado Anschutz
*Muhammad Aftab
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University of Colorado Anschutz
University of Colorado Anschutz
Presenting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Abstract:
Objective
Aortic remodeling from elephant trunk (ET) surgery has emerged as a valuable tool treating further degeneration after thoracic aortic dissection. However, many patients still require unplanned endovascular extension after pathology further degenerates. Identifying which patients are at risk based on pre-operative and initial post-operative imaging features may optimize surveillance strategies.
Methods
A single-center retrospective review of 320 patients who underwent ET from 2015-2023 was performed. Patients with non-dissection pathology, connective tissue disease, or absent post-operative surveillance imaging were excluded. Two cohorts were created from patients meeting criteria: those who required endovascular extension after surgery, and those who did not. Between the two cohorts, pre-operative and first post-operative surveillance computed tomography (CT) scans were reviewed, with emphasis placed on dissection and post-surgical feature differences. To optimize imaging review, TeraRecon Aquarius software was used for three-dimensional analysis and multiplanar renderings.
Results
Among included ET patients, 25 required extension and 25 did not. No significant differences were found in aortic tortuosity, character of thoracic entry tears, dissection extent, arch or visceral vessel dissection, cross-sectional minimum true lumen percentage, or evidence of radiographic malperfusion. Extension patients had a trend towards larger aortic diameters at time of presentation (p=0.07). Extension patients had less total false lumen area thrombosis in the covered area (p=0.02), with less complete false lumen thrombosis (p=0.01), and greater maximal aortic diameters in covered areas (p=0.05).
Conclusion
Persistent false lumen flow and incomplete thrombosis in covered regions after elephant trunk surgery, with associated increased aneurysm size, places patients at risk for unplanned endovascular extension. Patients with persistent false lumen flow warrant closer surveillance given risk of further degeneration of pathology.
Aortic remodeling from elephant trunk (ET) surgery has emerged as a valuable tool treating further degeneration after thoracic aortic dissection. However, many patients still require unplanned endovascular extension after pathology further degenerates. Identifying which patients are at risk based on pre-operative and initial post-operative imaging features may optimize surveillance strategies.
Methods
A single-center retrospective review of 320 patients who underwent ET from 2015-2023 was performed. Patients with non-dissection pathology, connective tissue disease, or absent post-operative surveillance imaging were excluded. Two cohorts were created from patients meeting criteria: those who required endovascular extension after surgery, and those who did not. Between the two cohorts, pre-operative and first post-operative surveillance computed tomography (CT) scans were reviewed, with emphasis placed on dissection and post-surgical feature differences. To optimize imaging review, TeraRecon Aquarius software was used for three-dimensional analysis and multiplanar renderings.
Results
Among included ET patients, 25 required extension and 25 did not. No significant differences were found in aortic tortuosity, character of thoracic entry tears, dissection extent, arch or visceral vessel dissection, cross-sectional minimum true lumen percentage, or evidence of radiographic malperfusion. Extension patients had a trend towards larger aortic diameters at time of presentation (p=0.07). Extension patients had less total false lumen area thrombosis in the covered area (p=0.02), with less complete false lumen thrombosis (p=0.01), and greater maximal aortic diameters in covered areas (p=0.05).
Conclusion
Persistent false lumen flow and incomplete thrombosis in covered regions after elephant trunk surgery, with associated increased aneurysm size, places patients at risk for unplanned endovascular extension. Patients with persistent false lumen flow warrant closer surveillance given risk of further degeneration of pathology.
Aortic Symposium:
Aortic Arch
Image or Table
