Anatomic predictors of distal landing zone failure after endovascular repair of thoracic aortic aneurysm
Nicholas J Goel, Andrew M Peev, Peter Auteri, Grace J Wang, Kendall M Lawrence, Alexandra E Sperry, Mikolaj Berezowski, Murat Yildiz, Waseem Lutfi, John Depaolo, Yu Zhao, Alexander S Fairman, Wilson Y Szeto, Darren B Schneider, Nimesh D DesaiAbstract
OBJECTIVES
To analyze anatomic factors of the distal landing zone associated with the durability of endovascular repair of thoracic aortic aneurysm (TAA).
METHODS
Consecutive patients undergoing TEVAR for undissected TAA were queried from a single center from 2004 to 2022. Patient and operative factors where considered as well as detailed anatomic factors at the distal landing zone assessed by 3D reconstruction of pre-TEVAR imaging. The outcome of interest was the long-term risk of TEVAR failure at the distal landing zone (dLZ).
RESULTS
A total of 101 patients undergoing TEVAR repair of TAA were considered, of whom 17 suffered distal TEVAR failure over a median follow-up period of 2.7 years. Two anatomic factors showed outsized influence on long-term outcomes: dLZ diameter and dLZ length (the length of non-dilated aortic tissue above the coeliac artery). Patients that progressed to distal TEVAR failure had larger dLZ diameter (34.2 mm vs 30.7 mm, p = 0.034) and far shorter dLZ length (3.8 cm vs 7.5 cm, p = 0.008). Patients with dLZ diameter greater than 35 mm had much greater risk of mortality or distal TEVAR failure within two years (34% vs 5%, p = 0.012), as did those with dLZ length less than 4 cm (27% vs 6%, p = 0.006).
CONCLUSIONS
In this study, mild dilation at the distal landing zone beyond 35 mm and short length at the distal landing zone less than 4 cm are both clear anatomic risk factors for poor long-term outcome after supraceliac TEVAR. It may be appropriate to consider repair via branched endografts landing beyond the coeliac artery in patients with these risk factors.