Volumetric analysis on computed tomography Angiography in the management of thoracic aortic dissection in case of seven years follow-up period

Purpose. To establish the methods for estimating the volume of the true and false aortic canals applying computed tomography angiography (CTA) to a clinical case with hybrid stent-graft thoracic aorta with distal stent-graftinduced new entry associated (d-SINE) in the long-term follow-up period in comparison with a widely used technique of measuring diameters of the aorta on different levels.

Materials and methods. Sequential analysis of CTA in a 7-year follow-up was performed. Aorta was divided into 3 segments, in each segment total aortic volumes (AV), volume of the true canal (TC), and volume of functional lumen of the false canal (FLFC) were calculated. The following were mathematically calculated: volume of the false canal (FC) via difference in volume between AV and TC, volume of the thrombosed lumen of FC as the difference between FC and FLFC, the coefficient of FC thrombosis, the degree of stent-graft opening. Mathematical assessment of excess volume of the graft was performed.

Results. Modelling of aortic cavity, evaluation of changes in the volumes of TC and FC during a long-term follow-up, analysis of the factors inducing the development of the d-SINE syndrome were performed. When comparing the volume of the graft and the volume of the implantation zone, an excess of 234% was found, while the opening of the graft was 80%. When using the reference method based on the diameter of the true lumen of the aorta, the excess was 22% during one-year follow-up period showing no changes subsequently.

Conclusion. Potentially, the method of measuring volumes based on CTA results can be used to complement the generally accepted method based on measuring diameters, since it does not require additional financial resources and has the potential to estimate effectiveness of treatment and identify complications predictors in the postoperative period to determine indications for reoperation. 

1. Berger T., Weiss G., Voetsch A. et al. Multicentre experience with two frozen elephant trunk prostheses in the treatment of acute aortic dissection. Eur. J. CardioThorac. Surg. 2019; 56 (3): 572–578. https://doi.org/10.1093/ejcts/ezz037

2. Kreibich M., Bünte D., Berger T. et al. Distal Stent GraftInduced New Entries After the Frozen Elephant Trunk Procedure. Ann. Thorac. Surg. 2020; 110 (4): 1271–1279. https://doi.org/10.1016/j.athoracsur.2020.02.017

3. Dong Z., Fu W., Wang Y. et al. Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection. J. Vasc. Surg. 2010; 52 (6): 1450–1457. https://doi.org/10.1016/j.jvs.2010.05.121

4. Cekmecelioglu D., Coselli J.S. Aortic arch repair with frozen elephant trunk versus conventional elephant trunk. Ann. Cardiothorac. Surg. 2020; 9 (3): 223–225. https://doi.org/10.21037/acs.2020.02.11

5. Furutachi A., Takamatsu M., Nogami E. et al. Early and mid-term outcomes of total arch replacement with the frozen elephant trunk technique for type A acute aortic dissection. Interact Cardiovasc. Thorac. Surg. 2019; 29 (5): 753–760. https://doi.org/10.1093/icvts/ivz154

6. Tsagakis K., Pacini D., Grabenwöger M. et al. Results of frozen elephant trunk from the international E-vita Open registry. Ann. Cardiothorac. Surgery. 2020; 9 (3): 178. https://doi.org/10.21037/acs-2020-fet-25

7. Chernyavskiy A.M., Alsov S.A., Lyashenko M.M., Sirota D.A., Khvan D.S. “Hybrid” prosthesis for arch and proximal thoracic aorta reconstruction in cases of DeBakey type I aortic dissection. Russian Journal of Thoracic and Cardiovascular Surgery = Grudnaya i Serdechno- Sosudistaya Khirurgiya. 2012; 5: 11–15. (In Russian)

8. Dohle D.S., Tsagakis K., Janosi R.A. et al. Aortic remodelling in aortic dissection after frozen elephant trunk. Eur. J. Cardio-Thorac. Surg. 2016; 49 (1): 111–117. https://doi.org/10.1093/ejcts/ezv045

9. Erbel R., Aboyans V., Boileau C. et al; ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur. Heart J. 2014; 35 (41): 2873–2926. https://doi.org/10.1093/eurheartj/ehu281

10. Hughes G.C. Stent graft-induced new entry tear (SINE): Intentional and NOT. J. Thorac. Cardiovasc. Surg. 2019; 157 (1): 101. https://doi.org/10.1016/j.jtcvs.2018.10.060

11. Xu S.D., Huang F.J., Du J.H. et al. A study of aortic dimension in type B aortic dissection. Interact. Cardiovasc. Thorac. Surg. 2008; 7 (2): 244–248. https://doi.org/10.1510/icvts.2007.163154

12. Huang C.Y., Weng S.H., Weng C.F. et al. Factors predictive of distal stent graft-induced new entry after hybrid arch elephant trunk repair with stainless steelbased device in aortic dissection. J. Thorac. Cardiovasc. Surg. 2013; 146 (3): 623–630. https://doi.org/10.1016/j.jtcvs.2012.07.052

13. Li Q., Wang L.F., Ma W.G. et al. Risk factors for distal stent graft-induced new entry following endovascular repair of type B aortic dissection. J. Thorac. Dis. 2015; 7 (11): 1907. https://doi.org/10.3978/j.issn.2072-1439.2015.11.27

14. Tsagakis K., Jakob H. Which frozen elephant trunk offers the optimal solution? Reflections from Essen group. Seminars in thoracic and cardiovascular surgery. W.B. Saunders. 2019; 31 (4): 679–685. https://doi.org/10.1053/j.semtcvs.2019.05.038

15. Jakob H., Tsagakis K., Leyh R. et al. Development of an integrated stent graft-dacron prosthesis for intended onestage repair in complex thoracic aortic disease. Herz. Kardiovaskuläre Erkrankungen. 2005; 30 (8): 766–768. https://doi.org/10.1007/s00059-005-2765-7