Validation of a Novel Methodology to Evaluate Changes in the Flare Geometry of Renovisceral Bridging Stent-Grafts After Fenestrated Endovascular Aneurysm Repair
Restricted accessResearch articleFirst published online June, 2020
Validation of a Novel Methodology to Evaluate Changes in the Flare Geometry of Renovisceral Bridging Stent-Grafts After Fenestrated Endovascular Aneurysm Repair
Purpose: To validate a novel method to evaluate changes in the geometry of renovisceral bridging stent-grafts (BSGs) in patients undergoing fenestrated endovascular aneurysm repair (fEVAR). Materials and Methods: Retrospective analysis was conducted of serial computed tomography angiograms (CTAs) of 10 fEVAR patients (31 BSGs) with at least 2 years of CTA follow-up. Centerline reconstructions were made through the fenestrated stent-graft (FSG) and each BSG. Flare geometry was reconstructed based on marker coordinates and a mesh of the aortic lumen. The shortest distance was calculated from the top of the flare circumference to the FSG fabric. The amount of flaring was assessed with the flare to fenestration diameter ratio and BSG compression to diameter ratio (D-ratio). All measurements were performed by 2 observers. Interobserver variability was assessed; results are presented as the intraclass correlation coefficient (ICC) and repeatability coefficient (RC). Results: Excellent interobserver agreement was achieved for BSG diameter and flare to fenestration distance calculations (ICC 0.865 and 0.944; RC 2.2% and 4.5%, respectively). Six patients had BSG-related complications during follow-up: 2 type IIIc endoleaks and 4 BSG occlusions. Five of the 6 BSGs with complications showed a considerable change in the D-ratio compared with the first postoperative CTA. Conclusion: Precise assessment of the geometry of visceral BSGs in fEVAR is feasible with the presented method. Geometrical changes that may precede later complications can be detected, which could aid in localization of the origin, but a larger series of patients is necessary to define its true clinical merit.
British Society for Endovascular Therapy and the Global Collaborators on Advanced Stent-Graft Techniques for Aneurysm Repair (GLOBALSTAR) Registry. Early results of fenestrated endovascular repair of juxtarenal aortic aneurysms in the United Kingdom. Circulation. 2012;125:2707–2715.
2.
O’CallaghanAGreenbergRKEagletonMJ, et al. Type Ia endoleaks after fenestrated and branched endografts may lead to component instability and increased aortic mortality. J Vasc Surg. 2015;61:908–914.
3.
RoyIMillenAMJonesSM, et al. Long-term follow-up of fenestrated endovascular repair for juxtarenal aortic aneurysm. Br J Surg. 2017;104:1020–1027.
4.
KristmundssonTSonessonBDiasN, et al. Outcomes of fenestrated endovascular repair of juxtarenal aortic aneurysm. J Vasc Surg. 2014;59:115–120.
5.
OderichGS.Endovascular Aortic Repair. Current Techniques with Fenestrated, Branched and Parallel Stent-Grafts. Cham Switzerland: Springer International; 2017. ISBN 978-3-319-15192-2
6.
OvereemSPDonselaarEJReijnenMMPJ. In vitro quantification of gutter formation and chimney graft compression in chimney EVAR stent-graft configurations using electrocardiography-gated computed tomography. J Endovasc Ther. 2018;25:387–394.
7.
British Standards Institution. Precision of Test Methods I. Guide for the Determination and Reproducibility for a Standard Test Method. London, England: British Standards Institution; 1979.
8.
UlleryBWSuhGYLeeJT, et al. Geometry and respiratory-induced deformation of abdominal branch vessels and stents after complex endovascular aneurysm repair. J Vasc Surg. 2015;61:875–884.
9.
UlleryBWSuhGLeeJT, et al. Comparative geometric analysis of renal artery anatomy before and after fenestrated or snorkel/chimney endovascular aneurysm repair. J Vasc Surg. 2016;63:922–929.
10.
De NietAPostRBReijnenMMPJ.Geometric changes over time in bridging stents after branched and fenestrated endovascular repair for thoracoabdominal aneurysm. J Vasc Surg. 2019;770:702–709.
11.
SuhGChoiGHerfkensRJ, et al. Respiration-induced deformations of the superior mesenteric and renal arteries in patients with abdominal aortic aneurysms. J Vasc Interv Radiol. 2013;24:1035–1042.
12.
GhatwaryTKarthikesalingamAPattersonB, et al. St George’s Vascular Institute Protocol: an accurate and reproducible methodology to enable comprehensive characterization of infrarenal abdominal aortic aneurysm morphology in clinical and research applications. J Endovasc Ther. 2012;19:400–414.
13.
BannoHKobeiterHBrossierJ, et al. Inter-observer variability in sizing fenestrated and / or branched aortic stent-grafts. Eur J Vasc Endovasc Surg. 2013;47:45–52.
14.
OshinOAEnglandAMcWilliamsRG, et al. Intra- and interobserver variability of target vessel measurement for fenestrated endovascular aneurysm repair. J Endovasc Ther. 2010;17:402–407.
15.
SchuurmannRCLOvereemSPOurielK, et al. A semiautomated method for measuring the 3-dimensional fabric to renal artery distances to determine endograft position after endovascular aneurysm repair. J Endovasc Ther. 2017;24:5–15.
16.
DraneyMTZarinsCKTaylorCA.Three-dimensional analysis of renal artery bending motion during respiration. J Endovasc Ther. 2005;12:380–386.
17.
MuhsBEVinckenKLTeutelinkA, et al. Dynamic cine-computed tomography angiography imaging of standard and fenestrated endografts: differing effects on renal artery motion. Vasc Endovascular Surg. 2008;42:25–31.
