anatomical assessment of the aortic arch: relationship between arch anatomy and age
DESCRIPTION
Anatomical Assessment of the Aortic Arch: Relationship between Arch Anatomy and Age. Sinan Jabori, J.P. Finn MD, Steven Farley MD, R.S. Saleh MD, Wesley S. Moore MD, Peter F. Lawrence MD, Brian G. DeRubertis MD. 2. Type I: 58%. Type II:24%. - PowerPoint PPT PresentationTRANSCRIPT
Arch type•
Conclusion
•High resolution MRA can provide objective quantification of morphologic changes occurring in the aortic arch with age.•Patients aged >60yrs have increased tendency for complex aortic arch anatomy: increased type III arch, increased ROC and increased vessel angulation.•These anatomic factors may relate to poorer outcomes in older patients undergoing endovascular interventions.
Sinan Jabori, J.P. Finn MD, Steven Farley MD, R.S. Saleh MD, Wesley S. Moore MD, Peter F. Lawrence MD, Brian G. DeRubertis MD
Background
•Octogenarians have been shown to be at increased risk of complications while undergoing carotid stenting.
•Risk is thought to be related to changes in Aortic Arch anatomy.
Results
Mean Age 60yrs (19-89)
Indication Percentage
Cardiac Evaluation
Abdominal Aneursym Screening
Other (CA, pulm HT, etc)
73%
12%
15%
Comorbidities Percentage
Hypercholesterolemia
Coronary artery disease
Cardiac Arrhythmia
Carotid stenosis
Stroke
Hypertension
Peripheral arterial disease
Diabetes
Chronic renal insufficiency
54%
31%
63%
5%
14%
53%
11%
6%
10%
Objective
•Perform an Evaluation of the Aortic Arch Anatomy with High-resolution MRA.
•Assess the Changes that Occur in the Aortic Arch with Aging
Type I: 58% Type II:24%
Future directions
•Evaluate force vectors throughout the arch to predict or explain the changes observed, and correlate with hemodynamic data (ie: HTN).•Assess changes throughout different sections of arch (ie: are vessels tethered/fixed by arch vessels)•Correlate arch anatomy to neurologic complications or procedural times.
Hypothesis
•Aortic Arch anatomy will change with time in a manner which increases risk with carotid stenting.
Method• 350 consecutive patients undergoing CT or MR angio of the aortic arch.• Gadolinium-enhanced chest MRA (3T Scanner)• Blinded analysis with Osirix Imaging Software• Data recorded •Congenital Arch Anomalies•Arch Type•Arch Radius of Curvature•Branch Vessel Angles and Diameters
Type III: 18%
Arch type. which is known to impact the difficulty of endovascular interventions in the aortic arch, was assessed in all patients and was classified as type I, type II, or type III, depending on whether the branch vessels originated above, between, or below the greater and lesser curvatures of the arch. Type I was most common, occurring in 58% of patients, while type III occurred in only 18%.
Radius of Curvature •
0
1
2
3
4
5
6
15 25 35 45 55 65 75 85 95
Age
Rad
ius
of C
urva
ture
`
Strong correlation between age and aortic arch ROC (R2=0.60, p<0.0001)
This arch elongation and the broadness of the arch can be quantified by placing an asculating circle over the region of maximum curvature, then calculating the radius of this curvature.
Age and Aortic Diameters
DESC. DIAM.=1.39+0.012Age P<0.001
R2 = 0.27
11.
52
2.5
3
20 40 60 80 100age
descdiam Fitted values95% CI Fitted values
ASC. DIAM.=1.96+0.0185Age P<0.001
R2 = 0.26
1.5
22.
53
3.5
20 40 60 80 100age
ASCDIAM Fitted values95% CI Fitted values
Ascending Thoracic Aorta Descending Thoracic Aorta
Age and Aortic Diameters (non-aneurysmal patients)
1
2
3
3
4