title: Impact of Thoracic Endovascular Aortic Repair on Pulsatile Circumferential and Longitudinal Strain in Patients With Aneurysm.
abstract: To quantify both pulsatile longitudinal and circumferential aortic strains before and after thoracic endovascular aortic repair (TEVAR), potentially clarifying TEVAR-related complications.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: 1 Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy.|2 Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands.
authors.forename: Foeke J H
authors.initials: FJ
authors.lastname: Nauta
authors.affiliation: 1 Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy.|2 Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands.
authors.forename: Guido H W
authors.initials: GH
authors.lastname: van Bogerijen
authors.affiliation: 3 Istituto Universitario di Studi Superiori di Pavia (IUSS), Pavia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Trentin
authors.affiliation: 4 Department of Civil Engineering and Architecture, Structural Mechanics Division, University of Pavia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Conti
authors.affiliation: 3 Istituto Universitario di Studi Superiori di Pavia (IUSS), Pavia, Italy.|4 Department of Civil Engineering and Architecture, Structural Mechanics Division, University of Pavia, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Auricchio
authors.affiliation: 2 Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands.
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.affiliation: 2 Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands.
authors.forename: Joost A
authors.initials: JA
authors.lastname: van Herwaarden
authors.affiliation: 1 Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy.
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001696:Biomechanical Phenomena; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011673:Pulsatile Flow; D012189:Retrospective Studies; D015607:Stents; D013314:Stress, Mechanical; D016896:Treatment Outcome
keywords: 3D reconstructions; arterial stiffness; complications; computed tomographic angiography; stent-graft; strain; thoracic aortic aneurysm; thoracic endovascular aortic repair