P286. Residual Flow in Covered Area After Elephant Trunk Predicts Unplanned Endovascular Extension
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
University of Colorado Anschutz
Denver, CO
United States - Contact Me
Adam Carroll is a current PGY-3 surgical resident at the University of Colorado. Adam attended medical school at the University of Colorado and has been involved in research with the cardiothoracic surgery department throughout medical school and residency. He has interest specifically in endovascular and transcatheter aortic interventions, as well as neurologic outcomes in aortic research. He is currently in the aortic surgery research labaratory in the Department of Cardiothoracic Surgery at the University of Colorado. He plans to pursue a career in cardiothoracic surgery following his general surgery residency.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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.
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
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.
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
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.
View Submission
- P0286 - Residual Flow in Covered Area After Elephant Trunk Predicts Unplanned Endovascular Extension