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OBJECTIVES: Reimplantation of branch vessels is an important component of thoraco-abdominal aortic aneurysm repair. The goal of this study was to assess the anatomical results of branch vessel reimplantation, which have rarely been investigated. METHODS: Among 168 patients who underwent computed tomography after thoraco-abdominal aortic aneurysm repair, the technique of branch vessel reimplantation and determination of their patency were investigated. Late computed tomographic images were available for 81 patients (mean interval 55.7 ± 29.4 months); they were examined for long-term changes. RESULTS: The early patency rate of the coeliac trunk (n = 150), superior mesenteric artery (n = 126) and right renal artery (n = 109) was 100%, regardless of the reimplantation technique. For 101 left renal arteries reimplanted end-to-end to the branch grafts, the early patency rate was 94.1%. Late new occlusion was found in 1 of 44 (2.3%) of the right renal arteries and in 1 of 53 (1.9%) of the left renal arteries reimplanted into the branch grafts. The patency rate of 240 segmental (intercostal or lumbar) arteries reimplanted in 116 patients differed based on the reimplantation technique used: 92.1% for a large multiple-branch patch, 83.0% for a single-branch patch and 31.0% for graft interposition. Spinal cord ischaemia was significantly more frequent in patients who had occlusion of reimplanted segmental arteries than in the remaining patients: 18.2% vs 4.4% (P = 0.022). Late computed tomography revealed ≥5mm dilatation in 2 of 41 visceral branch patches (4.9%) and in 9 of 55 segmental artery patches (16.4%). CONCLUSIONS: Visceral branches reimplanted during thoraco-abdominal aortic aneurysm repair showed excellent patency. In contrast, segmental artery reimplantation by graft interposition showed a high rate of occlusion that was associated with a higher incidence of spinal cord ischaemia. [ABSTRACT FROM AUTHOR]

OBJECTIVES: For a moderately dilated ascending aorta (diameter 35–54 mm), current guidelines recommend continuous annual or semiannual examinations with computed tomography or magnetic resonance imaging. However, few data have shown the yield and benefit of such a protocol. This study aimed to investigate the fate of a moderately dilated ascending aorta and thereby determine the adequate imaging interval. METHODS: In our institutional database, we identified adult patients having an ascending aortic diameter >40mm in contrast-enhanced computed tomography and follow-up imaging(s) after >1 year. Of the 509 patients (mean age 67.2 ± 10.4 years) enrolled in the study, the maximal diameter of the ascending aorta was compared between the first and last images. Also, their medical records were reviewed to investigate the associated illness and clinical events. RESULTS: The mean growth rate of the patients with a 40–44mm (n = 321), 45–49mm (n = 142) and >50mm (n = 46) ascending aorta was 0.3 ± 0.5, 0.3 ± 0.5 and 0.7 ± 0.9 mm/year, respectively. During the mean interval of 4.3 ± 2.4 years, significant progression (diameter increase by >5 mm) occurred in 3.4, 5.6 and 21.7%, respectively. The 3- to 5-year rates of freedom from significant progression were 99.1%–96.5% (40–44 mm) and 97.8%–96.4% (45–49 mm). In multivariate analysis, initial ascending aortic diameter >45mm and aortic valve regurgitation were significantly associated with significant progression. Acute type A aortic dissection occurred in 5 patients (1%), before the maximal diameter of the ascending aorta reached 55mm or significant progression was observed. CONCLUSIONS: For a moderately dilated ascending aorta not exceeding 45mm in maximal diameter and stable in the first annual follow-up image, a 3- to 4-year interval would be reasonable before subsequent imaging. More frequent imaging may be warranted in patients with aortic valve insufficiency or with an aortic diameter >45 mm. [ABSTRACT FROM AUTHOR]