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ORIGINAL ARTICLE  VASCULAR SECTION Open accessopen access

The Journal of Cardiovascular Surgery 2022 August;63(4):454-63

DOI: 10.23736/S0021-9509.22.11980-4

Copyright © 2022 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC 4.0 license which allows users to distribute, remix, adapt and build upon the manuscript, as long as this is not done for commercial purposes, the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI), provides a link to the license and indicates if changes were made.

language: English

Evaluation of electrocardiogram-gated computed tomography angiography to quantify changes in geometry and dynamic behavior of the iliac artery after placement of the Gore Excluder Iliac Branch Endoprosthesis

Majorie van HELVERT 1, 2, Jaimy A. SIMMERING 1, 3 , Maaike A. KOENRADES 1, 4, Cornelis H. SLUMP 5, Jan M. HEYLIGERS 6, Robert H. GEELKERKEN 1, 3, Michel M. REIJNEN 1, 2

1 Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands; 2 Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands; 3 Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands; 4 Department of Medical Technology, Medical 3D lab, Medisch Spectrum Twente, Enschede, the Netherlands; 5 Robotics and Mechatronics Group, TechMed Centre, University of Twente, Enschede, the Netherlands; 6 Department of Vascular Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands



BACKGROUND: The GORE® EXCLUDER® Iliac Branch Endoprosthesis (IBE) is designed to treat iliac aneurysms with preservation of blood flow through the internal iliac artery (IIA). Little is known about the influence of IBE placement on the IIA geometry. This study aimed to provide detailed insights in the dynamic behavior and geometry of the common iliac artery (CIA) and IIA trajectory and how these are influenced after treatment with an IBE.
METHODS: Pre- and postoperative electrocardiogram-gated computed tomography angiography (ECG-gated CTA) scans were acquired in a prospective study design and analyzed with in-house written algorithms designed for aorto-iliac and endoprosthesis deformation evaluation. Cardiac pulsatility-induced motion patterns and pathlengths were computed by tracking predefined locations on the aorto-iliac tract. Centerlines through the CIA-IIA trajectory were used to investigate the static and dynamic geometry, including curvature, torsion, length and Tortuosity Index (TI).
RESULTS: Fourteen CIA-IIA trajectories were analyzed before and after IBE placement. Cardiac pulsatility-induced motion and pathlengths increased after IBE placement, especially at mid IIA and the first IIA bifurcation (P≤0.04). After IBE placement, static and dynamic curvature, length and TI decreased significantly (P<0.05). Furthermore, the average dynamic torsion increased significantly (P=0.030). The remaining geometrical outcomes were not statistically significant.
CONCLUSIONS: The placement of an IBE device stiffens and straightens the CIA-IIA trajectory. Its relation with clinical outcome is yet to be investigated, which can be done thoroughly with the ECG-gated CTA algorithms used in this study.


KEY WORDS: Iliac aneurysm; Blood vessels; Computed tomography angiography

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