Impact of Thoracic Endovascular Aortic Repair on Pulsatile Circumferential and Longitudinal Strain in Patients With Aneurysm

Abstract

Purpose: To quantify both pulsatile longitudinal and circumferential aortic strains before and after thoracic endovascular aortic repair (TEVAR), potentially clarifying TEVAR-related complications. Methods: This retrospective study assessed the impact of TEVAR on pulsatile aortic strains through custom developed software and cardiac-gated computed tomography imaging of 8 thoracic aneurysm patients (mean age 71.0±8.2 years; 6 men) performed before TEVAR and during follow-up (median 0.1 months, interquartile range 0.1–5.8). Lengths of the ascending aorta, the aortic arch, and the descending aorta were measured. Diameters and areas were computed at the sinotubular junction, brachiocephalic trunk, left subclavian artery, and the celiac trunk. Pulsatile longitudinal and circumferential strains were quantified as systolic increments of length and circumference divided by the corresponding diastolic values. Results: Average pulsatile longitudinal strain ranged from 1.4% to 7.1%, was highest in the arch (p<0.001), and increased after TEVAR by 77% in the arch (7.1%±2.5% vs 12.5%±5.1%, p=0.04) and by 69% in the ascending aorta (5.6±2.3% vs 9.4±4.4%, p=0.06). Average pulsatile circumferential strain ranged from 3.6% to 5.0% before TEVAR and did not differ significantly throughout the thoracic aorta; there was a nonsignificant increase after TEVAR at the unstented sinotubular junction (5.0%±1.4% vs 6.3%±1.0%, p=0.18), with a significant increase at the celiac trunk (3.6%±1.8% vs 6.2%±1.8%, p=0.02). Pulsatile circumferential strains within stented segments were deemed unreliable due to image artifacts. Conclusion: TEVAR was associated with an increase of pulsatile longitudinal strains (in the arch) and circumferential strains (at the celiac trunk) in unstented aortic segments. These observations suggest increased pulsatile wall stress after TEVAR in segments adjacent to the device, which may contribute to the understanding of stent-graft–related complications such as retrograde dissection, aneurysm formation, and rupture.

Keywords

3D reconstructions arterial stiffness complications computed tomographic angiography thoracic endovascular aortic repair thoracic aortic aneurysm strain stent-graft

Get full access to this article

View all access options for this article.

References

Bell

Mitchell

Sigurðsson

. Longitudinal and circumferential strain of the proximal aorta. J Am Heart Assoc. 2014;3:e001536.

Beller

Labrosse

Thubrikar

. Role of aortic root motion in the pathogenesis of aortic dissection. Circulation. 2004;109:763–769.

Morrison

Choi

Zarins

. Circumferential and longitudinal cyclic strain of the human thoracic aorta: age-related changes. J Vasc Surg. 2009;49:1029–1036.

van Prehn

Vincken

Sprinkhuizen

. Aortic pulsatile distention in young healthy volunteers is asymmetric: analysis with ECG-gated MRI. Eur J Vasc Endovasc Surg. 2009;37:168–174.

van Keulen

Moll

Barwegen

. Pulsatile distension of the proximal aneurysm neck is larger in patients with stent graft migration. Eur J Vasc Endovasc Surg. 2010;40:326–331.

Kleinstreuer

Basciano

. Computational mechanics of Nitinol stent grafts. J Biomech. 2008;41:2370–2378.

Roccabianca

Figueroa

Tellides

. Quantification of regional differences in aortic stiffness in the aging human. J Mech Behav Biomed Mater. 2014;29:618–634.

Raaz

Zöllner

Schellinger

. Segmental aortic stiffening contributes to experimental abdominal aortic aneurysm development. Circulation. 2015;131:1783–1795.

Dong

Wang

. Retrograde type A aortic dissection after endovascular stent graft placement for treatment of type B dissection. Circulation. 2009;119:735–741.

10.

Dong

Wang

. Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection. J Vasc Surg. 2010;52:1450–1457.

11.

Huang

Luo

. Perioperative aortic dissection rupture after endovascular stent graft placement for treatment of type B dissection. Chin Med J (Engl). 2013;126:1636–1641.

12.

Dobson

Flewitt

Tyberg

. Endografting of the descending thoracic aorta increases ascending aortic input impedance and attenuates pressure transmission in dogs. Eur J Vasc Endovasc Surg. 2006;32:129–135.

13.

Hirst

Johns

Kime

SW.

Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore). 1958;37:217–279.

14.

Khanafer

Duprey

Zainal

. Determination of the elastic modulus of ascending thoracic aortic aneurysm at different ranges of pressure using uniaxial tensile testing. J Thorac Cardiovasc Surg. 2011;142:682–686.

15.

Brekken

Dahl

Hernes

. Reduced strain in abdominal aortic aneurysms after endovascular repair. J Endovasc Ther. 2008;15:453–461.

16.

Yushkevich

Piven

Hazlett

. User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage. 2006;31:1116–1128.

17.

Piccinelli

Veneziani

Steinman

. A framework for geometric analysis of vascular structures: application to cerebral aneurysms. IEEE Trans Med Imaging. 2009;28:1141–1155.

18.

Trentin

Faggiano

Conti

Auricchio

. An automatic tool for thoracic aorta segmentation and 3D geometric analysis. Image Signal Process Anal ISPA 2015 9th Int Symp. http://ieeexplore.ieee.org/xpl/mostRecentIssue.jsp?filter%3DAND%28p_IS_Number%3A7306014%29&refinements=4223999752&pageNumber=1&resultAction=REFINE

19.

Lin

LI.

A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989;45:255–268.

20.

von Allmen

Anjum

Powell

JT.

Incidence of descending aortic pathology and evaluation of the impact of thoracic endovascular aortic repair: a population-based study in England and Wales from 1999 to 2010. Eur J Vasc Endovasc Surg. 2013;45:154–159.

21.

Perera

Rudarakanchana

Hamady

. New-generation stent grafts for endovascular management of thoracic pseudoaneurysms after aortic coarctation repair. J Vasc Surg. 2014;60:330–336.

22.

White

Mulligan

Gorin

. Response of normal aorta to endovascular grafting: a serial histopathological study. Arch Surg. 1998;133:246–249.

23.

Scheumann

Heilmann

Beyersdorf

. Early histological changes in the porcine aortic media after thoracic stent-graft implantation. J Endovasc Ther. 2012;19:363–369.

24.

Takeda

Sakata

Ohtani

. Endovascular aortic repair increases vascular stiffness and alters cardiac structure and function. Circ J. 2014;78:322–328.

25.

Tzilalis

Kamvysis

Panagou

. Increased pulse wave velocity and arterial hypertension in young patients with thoracic aortic endografts. Ann Vasc Surg. 2012;26:462–467.

26.

Belz

GG.

Elastic properties and Windkessel function of the human aorta. Cardiovasc Drugs Ther. 1995;9:73–83.

27.

Patterson

Holt

Nienaber

. Aortic pathology determines midterm outcome after endovascular repair of the thoracic aorta: report from the Medtronic Thoracic Endovascular Registry (MOTHER) database. Circulation. 2013;127:24–32.

28.

Redheuil

Kachenoura

. Proximal aortic distensibility is an independent predictor of all-cause mortality and incident CV events: the MESA study. J Am Coll Cardiol. 2014;64:2619–2629.

29.

Faggiano

Lorenzi

Quarteroni

Metal artefact reduction in computed tomography images by a fourth-order total variation flow. CMBBE: Imaging & Visualization. 2014;1:1–12.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB