Changes in Ascending Aorta and Aortic Arch Secondary Flow Patterns Following Endovascular Repair of the Descending Thoracic Aorta.

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery Pub Date : 2025-05-10 DOI:10.1016/j.ejvs.2025.05.005

Alexandra Hauguel, Kianosh Kasani, Virgile Chevance, Xingjian Zhang, Abdul I Barakat, Stephan Haulon, Arshid Azarine

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引用次数: 0

Abstract

Objective: This study aimed to assess modifications of aortic secondary flow patterns following thoracic endovascular aortic repair (T-EVAR) using four dimensional flow magnetic resonance imaging (4D flow MRI).

Methods: FASCAT is a French, prospective, observational, single centre study. All included patients underwent cardiac MRI, including aortic magnetic resonance angiography and 4D flow MRI acquisition, before and three months after T-EVAR. Visual and quantitative aortic flow patterns were assessed using Tempus Pixel Cardio and cvi42 software. Basic 4D flow MRI metrics such as aortic forward flow (AFF), aortic reverse flow (ARF), aortic net flow (ANF), and peak and mean velocities were initially assessed. 4D flow MRI derived advanced metrics such as pulse wave velocity (PWV) related to aortic stiffness, flow ejection angle, flow eccentricity (ECC), and mean systolic fraction of reverse flow (FRF) and their duration over systole (FRFd_sys and ECCd_sys, respectively) were also measured on pre- and post-operative MRIs.

Results: The analysis was conducted on 15 T-EVAR procedures in 14 patients (seven aneurysms and seven dissections). The median time between pre- and post-operative MRI was 122.8 ± 71.4 days. PWV statistically significantly increased within the stented segment (17.8 ± 12.1 cm/s vs. 9.4 ± 8.5 cm/s; p = .005), while it statistically significantly decreased upstream of the graft (8.8 ± 9.1 cm/s vs. 4.9 ± 6.2 cm/s; p = .035) post T-EVAR. No statistically significant changes were found in terms of mean AFF, ANF, velocities, or flow ejection angle pre to post T-EVAR. Mean systolic FRF statistically significantly decreased post T-EVAR (37%, 26%, and 48% at the sinotubular junction, mid ascending aorta, and T-EVAR inlet, respectively). FRFd_sys and ECCd_sys also statistically significantly decreased post T-EVAR.

Conclusion: This pre to post T-EVAR 4D flow MRI study found a statistically significant decrease in ARF and ECC upstream of the graft, suggesting improved upstream aortic flow fields post T-EVAR.

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胸降主动脉血管内修复后升主动脉和主动脉弓二次血流模式的变化。

目的：本研究旨在利用四维血流磁共振成像（4D flow MRI）评估胸血管内主动脉修复（T-EVAR）后主动脉二次血流模式的改变。方法：FASCAT是一项法国前瞻性、观察性、单中心研究。所有患者在T-EVAR前后三个月均行心脏MRI检查，包括主动脉磁共振血管造影和4D血流MRI采集。使用Tempus Pixel Cardio和cvi42软件评估可视化和定量的主动脉血流模式。初步评估了基本的4D血流MRI指标，如主动脉正流（AFF）、主动脉逆流（ARF）、主动脉净流（ANF）以及峰值和平均流速。4D血流MRI衍生的先进指标，如与主动脉硬度相关的脉冲波速度（PWV）、血流射角、血流偏心率（ECC）、平均收缩逆流分数（FRF）及其收缩持续时间（分别为FRFdsys和ECCdsys），也在术前和术后MRI上进行了测量。结果：对14例患者（7个动脉瘤和7个夹层）的15例T-EVAR手术进行了分析。术前和术后MRI的中位时间为122.8±71.4天。PWV在支架段内显著增加（17.8±12.1 cm/s vs 9.4±8.5 cm/s）；P = 0.005)，而在移植物上游(8.8±9.1 cm/s vs. 4.9±6.2 cm/s；p = 0.035)。在T-EVAR前后，平均AFF、ANF、速度或气流喷射角没有统计学上的显著变化。T-EVAR后平均收缩期FRF显著降低（分别在肾小管交界处、升主动脉中部和T-EVAR入口分别为37%、26%和48%）。FRFdsys和ECCdsys在T-EVAR后也显著降低。结论：T-EVAR前后的4D血流MRI研究发现移植物上游的ARF和ECC有统计学意义的降低，表明T-EVAR后上游主动脉流场有所改善。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.