Online citations, reference lists, and bibliographies.
Please confirm you are human
(Sign Up for free to never see this)
← Back to Search

Morphology Of Aortic Arch Pathology: Implications For Endovascular Repair

A. H. Malkawi, R. Hinchliffe, Martin Yates, P. Holt, I. Loftus, M. Thompson
Published 2010 · Medicine

Save to my Library
Download PDF
Analyze on Scholarcy
Purpose: To present a detailed description of aortic arch morphology in patients with aneurysm and dissection undergoing thoracic endovascular aortic repair (TEVAR). Methods: Morphological assessment of the aortic arch was performed in a consecutive series of patients undergoing TEVAR between November 2003 and April 2009. In the absence of standardized reporting criteria, any patient requiring overstenting of the left subclavian artery (LSA) was considered to have pathology of the aortic arch. In all, the arch morphology of 49 patients (31 men; mean age 70 years, range 43–86) was analyzed (25 aneurysms and 24 dissections). The proximal landing site of the intended stent-graft was Ishimaru zone 0 in 2 (4%) patients, zone 1 in 11 (22%), and zone 2 in 36 (74%). Measurements were made of the aortic arch diameters and angulation and the orientation and diameters of the supra-aortic trunks from 3-dimensional reconstructions of computed tomography scans. Results: The diameter of the aortic arch increased as it approached the aortic root (mean 38.9±6.4 mm at the sinotubular junction versus 30.7±16.6 mm at the left subclavian artery (LSA). Mean angulation of the arch at the level of the LSA was 117°±23°. Five (10%) patients had a common origin of the innominate artery and left common carotid artery (LCCA). The distance between the LCCA and the LSA was <15 mm in 80%; 37 (80%) had clock-face positions of the LCCA and LSA ostia within 15°; of each other. There was no statistical difference in any measurements between the aneurysm and dissection patients. Conclusion: In this cohort, morphology was similar for patients with aneurysm or dissection. The distance between the LCCA and the LSA in the majority of cases was shorter than the recommendation for an adequate proximal landing zone. This data may assist in the development of stent-grafts for the aortic arch.
This paper references
Toward an “Off-the-Shelf” Fenestrated Endograft for Management of Short-Necked Abdominal Aortic Aneurysms: An Analysis of Current Graft Morphological Diversity
I. Nordon (2010)
Factors favoring stent-graft collapse after thoracic endovascular aortic repair.
L. Canaud (2010)
Thoracic aortic aneurysm repair with an endovascular stent graft: the "first generation".
R. Mitchell (1999)
Analysis of Anatomic Factors and Age in Patients Undergoing Carotid Angioplasty and Stenting
Stephanie C. Lin (2005)
Results of endografting of the aortic arch in different landing zones.
G. Melissano (2007)
Endovascular total aortic arch replacement by in situ stent graft fenestration technique.
B. Sonesson (2009)
Endovascular treatment of thoracic aortic disease: Mid‐term follow‐up
M. Tespili (2007)
Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement.
C. Nienaber (1999)
Endovascular Treatment of Thoracic Aortic Aneurysms: Results of the Phase II Multicenter Trial of the GORE TAG Thoracic Endoprosthesis
M. Makaroun (2005)
Normal thoracic aorta diameter on cardiac computed tomography in healthy asymptomatic adults: impact of age and gender.
S. Mao (2008)
First International Summit on Thoracic Aortic Endografting: Roundtable on Thoracic Aortic Dissection as an Indication for Endografting
R. Mitchell (2002)
A multicenter clinical trial of endovascular stent graft repair of acute catastrophes of the descending thoracic aorta.
R. Cambria (2009)
Changes in aneurysm morphology and stent-graft configuration after endovascular repair of aneurysms of the descending thoracic aorta.
T. Resch (2001)
Subclavian carotid transposition and bypass grafting: consecutive cohort study and systematic review.
C. Cinà (2002)
The Chimney Graft: A Technique for Preserving or Rescuing Aortic Branch Vessels in Stent-Graft Sealing Zones
T. Ohrlander (2008)
Endovascular treatment of aortic arch aneurysms.
G. Melissano (2005)
Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis.
M. Makaroun (2005)
Stent-Graft Repair versus Open Surgery for the Descending Aorta: A Case-Control Study
M. Brandt (2004)
Assessment of the thoracic aorta by multidetector computed tomography: age- and sex-specific reference values in adults without evident cardiovascular disease.
F. Lin (2008)
Predictors of difficult carotid stenting as determined by aortic arch angiography.
S. Madhwal (2008)
Ready-to-fenestrate stent grafts in the treatment of juxtarenal aortic aneurysms: proposal for an off-the-shelf device.
B. Manning (2010)
Technical Strategies to Expand Stent-Graft Applicability in the Aortic Arch and Proximal Descending Thoracic Aorta
F. Criado (2002)
Great vessel management for endovascular exclusion of aortic arch aneurysms and dissections.
P. Bergeron (2006)
Observations on the failure of stent-grafts in the aortic arch.
R. Hinchliffe (2007)
Transposition of the supraaortic branches for extended endovascular arch repair.
M. Czerny (2006)
Endovascular repair of the thoracic aorta necessitating anchoring of the stent graft across the arch vessels.
M. Schoder (2006)
Anatomic factors associated with acute endograft collapse after Gore TAG treatment of thoracic aortic dissection or traumatic rupture.
B. Muhs (2007)
Ascending aortic curvature as an independent risk factor for type A dissection, and ascending aortic aneurysm formation: a mathematical model.
M. Poullis (2008)
Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review
K. Natsis (2008)
Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial.
J. Bavaria (2007)
Aortic arch reconstruction by transluminally placed endovascular branched stent graft.
K. Inoue (1999)

This paper is referenced by
Anatomic Feasibility of Next-Generation Stent Grafts for the Management of Type A Aortic Dissection in Japanese Patients.
N. Fujimura (2017)
Differences in aortic arch radius of curvature, neck size, and taper in patients with traumatic and aortic disease.
H. B. Alberta (2013)
The Prospects for Total Endovascular Repair of Acute Type A Aortic Dissection
I. Nordon (2014)
Surgically relevant aortic arch mapping using computed tomography.
A. Finlay (2012)
Partial debranching hybrid stent graft for distal aortic arch aneurysms
H. Ishibashi (2012)
Progress in endovascular management of type A dissection.
I. Nordon (2012)
The Role of Dual-Source Computed Tomography Angiography in Evaluating the Aortic Arch Vessels in Acute Type A Aortic Dissection: A Retrospective Study of 42 Patients
Fang Huang (2019)
Morphological Analysis of Healthy Aortic Arch.
M. Boufi (2017)
ACR Appropriateness Criteria® Suspected Thoracic Aortic Aneurysm.
S. Bennett (2018)
Anatomical Analysis and Feasibility Study of Next-Generation Fenestrated or Branched Stent-Grafts for the Treatment of Arch Aneurysms
N. Fujimura (2020)
The apex of the aortic arch backshifts with aging
N. D’ostrevy (2016)
CT patterns of acute type A aortic arch dissection: longer, higher, more anterior.
F. Ardellier (2017)
Proximal Bare Stent May Reduce Bird-Beak Configuration, Which is Associated with Distal Migration of Stent Graft in the Aortic Arch.
H. Banno (2019)
Aortic Anatomy and Complications of the Proximal Sealing Zone after Endovascular Treatment of the Thoracic Aorta.
Jérémie Peidro (2018)
Calculation of the aortic arch angles from three-dimensional reconstructions of computed tomography scans: Comparison between an automated program and visual assessment
J. Gaudric (2019)
New technique for passage of endograft through problematic arch anatomy.
Hitoshi Matsuda (2014)
Endovascular treatment for Stanford type A aortic dissection with entrance tear in ascending aorta
Alison Stanford (2015)
Análisis morfológico del arco aórtico en pacientes sometidos a cirugía híbrida y correlación con resultados a medio plazo
V. Mosquera (2014)
How should I treat a massive pulmonary haemorrhage secondary to a TEVAR procedure in a patient with a thoracic aortic aneurysm and a type B aortic dissection?
Andrea Tognarelli (2015)
Aortic Arch Anatomy Pattern in Patients Treated Using Double Homemade Fenestrated Stent-Grafts for Total Endovascular Aortic Arch Repair
L. Chassin-Trubert (2020)
Exploration of Simplified Intraluminal TEVAR Technique for the Treatment of Aortic Arch Disease
Bailang Chen (2020)
Predictor of false lumen thrombosis after thoracic endovascular aortic repair for type B dissection.
D. Li (2019)
Endovascular aortic repairs combined with looping-chimney technique for repairing aortic arch lesions and reconstructing left common carotid artery.
J. Zhang (2020)
Predictive Numerical Simulations of Double Branch Stent-Graft Deployment in an Aortic Arch Aneurysm
L. Derycke (2019)
A compliant aortic model for in vitro simulations: Design and manufacturing process.
S. Marconi (2018)
Applicability of a standardized thoracic endograft with a single branch for the left subclavian artery to treat aortic disease involving the distal arch.
J. Mougin (2020)
Early Postnatal Echocardiography in Neonates with a Prenatal Suspicion of Coarctation of the Aorta
T. Vigneswaran (2020)
Aortic Arch Morphology and Aortic Length in Patients with Dissection, Traumatic, and Aneurysmal Disease.
H. B. Alberta (2015)
Semantic Scholar Logo Some data provided by SemanticScholar