Takuya Ueda MD, Presenter: Nothing to Disclose

Dominik Fleischmann MD, Abstract Co-Author: Nothing to Disclose

Michael David Dake MD, Abstract Co-Author: Scientific Advisory Board, W. L. Gore & Associates, Inc Scientific Advisory Board, Abbott Laboratories Scientific Advisory Board, Medtronic, Inc Research grant, Siemens AG Research grant, Cook Group Incorporated

Geoffrey D. Rubin MD, Abstract Co-Author: Medical Advisory Board, Fovia, Inc Research grant, General Electric Company Speaker, Bracco Group

Daniel Y. Sze MD, PhD, Abstract Co-Author: Consultant, MediGene AG Consultant, Jennerex Biotherapeutics ULC Consultant, Pain Therapeutics, Inc Medical Advisory Board, Lunar Design, Inc Shareholder, National Distribution & Contracting, Inc

To determine the clinical significance of incomplete apposition of an endograft to the aortic arch ("bird-beak" configuration) after thoracic endovascular aortic repair (TEVAR) using 3D-CT angiography.

Sixty-four patients (40 men and 24 women; mean age, 64 years; range, 19-89 years) treated by TEVAR using Gore Thoracic Excluder or TAG endografts for aortic arch pathology were evaluated. The diseases treated included dissection (n=19), degenerative aneurysm (n=13), acute traumatic transection (n=9), pseudoaneurysm (n=4), penetrating aortic ulcer (n=2), intramural hematoma (n=2), and mycotic aneurysm (n=2). "Bird-beak" configuration, defined as incomplete apposition of the proximal endograft with a wedge-shaped gap between the device and the aortic wall along the lesser curve, was assessed by postprocedural CT angiography. Presence and length of bird-beak configuration were analyzed and correlated with formation of endoleaks and clinical adverse events.

Endoleaks were detected in 26 patients (40.1%) including 14 type Ia, 1 type Ib, 6 type IIs (from left subclavian artery), 2 type IIo (from other arteries), and 3 type III. Bird-beak configuration was observed in 28 patients (43.8%) and correlated with the risk of forming type Ia and IIa endoleaks (p<0.01). The mean bird-beak length was significantly longer in patients with type Ia (mean 14.3 mm) and type IIs (mean 13.9 mm) endoleaks compared with that of patients without endoleak (mean 8.4 mm) (p<0.01). Patients with bird-beak configuration measuring over 10 mm in length are at 50% risk of forming type Ia or type IIs endoleaks. Adverse events included 3 early aortic-related deaths, 8 additional reinterventions for endoleaks, and 5 stent-graft collapses/infoldings.

Bird-beak configuration after TEVAR is associated with type Ia and IIs endoleak formation. Patients with bird-beak configuration measuring over 10 mm in length are at high risk of forming type Ia or type IIs endoleaks.  

"Bird-beak"Awareness about bird-beak configuration is useful to guide postprocedural image interpretation and follow-up protocols and allow for preemptory procedural planning in TEVAR candidates.

Ueda, T, Fleischmann, D, Dake, M, Rubin, G, Sze, D, "Bird-beak" Configuration by Incomplete Endograft Apposition to the Aortic Arch: Significant Risk of Endoleak Formation after Thoracic Endovascular Aortic Repair.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8009577.html