Key result
A branch stent extension length >1.5 cm during in situ fenestration TEVAR with LSA reconstruction significantly increased the risk of asymptomatic hemodynamic changes compared to shorter extensions (43.9% vs 26.5%, p<0.0001).
Why the study?
Studying hemodynamics regarding thoracic endovascular aortic repair (TEVAR) is helpful to improve surgical efficacy.
Does branch stent extension length affect LSA hemodynamics in patients with Stanford type B aortic dissection undergoing ISF-TEVAR?
Cohort (n=196)
No
Does branch stent extension length affect LSA hemodynamics in patients with Stanford type B aortic dissection undergoing ISF-TEVAR?
Effect estimate: Spearman correlation coefficient 0.493
Absolute Event Rate: 43.9% vs 26.5%
p-value: p=<0.0001
In patients undergoing ISF-TEVAR for type B aortic dissection, a branch stent extension length >1.5 cm into the aortic arch significantly increases the risk of LSA hemodynamic changes.
May support shorter branch stent extensions in TEVAR; leaves open optimal LSA reconstruction length in prospective studies.
Background: The study of hemodynamics regarding thoracic endovascular aortic repair (TEVAR) is helpful to improve the surgical efficacy. Objective: fenestration TEVAR (ISF-TEVAR) involving the left subclavian artery (LSA) were evaluated. Materials and Methods: laser fenestrated thoracic endovascular aortic repair with LSA fenestration from April 2014 to March 2021. Branch stent extension to the main stent graft was evaluated by the computed tomographic angiography (CTA). Hemodynamic change of LSA was defined as a 20 mmHg interbrachial systolic pressure difference. The factors affecting the extension of the branch stent were also evaluated. Results: All patients underwent ISF-TEVAR with LSA fenestration, and there was no recurrence during the follow-up. The mean length of the branch stent extension was 10.37 ± 0.34 mm, which was used to divide the patients into long and short groups. Asymptomatic hemodynamic changes (defined as a 20 mmHg interbrachial systolic pressure difference) in LSA were observed in 61 patients undergoing ISF-TEVAR involving LSA fenestration. The Spearman correlation analysis showed extension length of a branch stent >1.5 cm elevated the risk of hemodynamic changes. Conclusion: Overall, we conclude that branch stent extension length >1.5 cm induced LSA hemodynamic changes. Appropriate shortening of the stent extension length can improve the curative effect of ISF-TEVAR, especially when faced with a type II/III aortic arch and stent angles of <30 degrees.
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Hu et al. (2022) conducted a cohort in Stanford type B aortic dissection (n=196). Branch stent extension length >1.5 cm vs. Branch stent extension length ≤1.5 cm was evaluated on Hemodynamic change in LSA (≥20 mmHg interbrachial systolic pressure difference) (Spearman correlation coefficient 0.493, p=<0.0001). A branch stent extension length >1.5 cm during in situ fenestration TEVAR with LSA reconstruction significantly increased the risk of asymptomatic hemodynamic changes compared to shorter extensions (43.9% vs 26.5%, p<0.0001).
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