Open Access
CC BY 4.0 · Aorta (Stamford) 2022; 10(S 01): A1-A56
DOI: 10.1055/s-0042-1750960
Presentation Abstracts

Determination of Optimal and Safest Proximal Sealing Length during Thoracic Endovascular Aortic Repair

Francesco Squizzato
1   Padua University, Padova, Italy
,
Michele Piazza
1   Padua University, Padova, Italy
,
Mirko Menegolo
1   Padua University, Padova, Italy
,
Carlo Maturi
1   Padua University, Padova, Italy
,
Franco Grego
1   Padua University, Padova, Italy
,
Michele Antonello
1   Padua University, Padova, Italy
› Author Affiliations
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    Objective: To determine the optimal and safest proximal sealing length (PSL) during thoracic endovascular aortic repair (TEVAR), depending on anatomical aortic arch types and proximal landing zones (LZ).

    Methods: We conducted a single-center retrospective observational study of consecutive TEVAR patients (2008–2020). All aortic pathologies requiring Ishimaru's LZ 0 to 3 were included; results were stratified by aortic arch type. The PSL was measured as the length of complete aortic wall-to-endograft apposition at the level of the proximal neck. The primary endpoint was proximal failure (type 1A endoleak, endograft migration, or reintervention requiring proximal graft extension). Freedom from proximal failure was estimated with Kaplan-Meier curves. An “optimal” sealing length (PSL cutoff maximizing sensitivity + specificity for proximal failure) and “safest length” (PSL cutoff determining ?90% sensitivity) were identified using ROC analysis.

    Results: One-hundred-forty patients received TEVAR; mean PSL was 29 ± 9 mm. Freedom from proximal endograft failure at 5 years (median, 31 months) was 82.4% (95% CI 72–95); the shorter the PSL, the higher was the risk of failure (HR 0.90, 95% CI 0.84–0.97; p = 0.004). Overall optimal and safest PSL were 25 mm (sensitivity 78%, specificity 66%) and 30 mm (sensitivity 92%, specificity 30%) respectively. In type I arch, the optimal PSL was 22 mm (sensitivity 50%, specificity 87%). In type II, the optimal PSL was 25 mm (sensitivity 89%, specificity 59%), 27 mm for type II/LZ 2–3 (sensitivity 31%, specificity 68%). For type III, the optimal PSL was 27 mm (sensitivity 80%, specificity 87%); the safest was 30 mm (sensitivity 100%, specificity 61%) In type III/LZ 2–3, optimal PSL was 27 mm (sensitivity 31%, specificity 68%) and safest was 30 mm (sensitivity 100%, specificity 55%).

    Conclusion: A 20mm PSL may be acceptable only for type I arches. For types II/III, that represent the majority of cases, a 25–30 mm PSL may be required for a safe and durable TEVAR.


     

    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    10 June 2022

    © 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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