Utility of Remote Wireless Pressure Sensing for Endovascular Leak Detection After Endovascular Thoracic Aneurysm Repair Cyrus J. Parsa, MD, Mani A. Daneshmand,

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Utility of Remote Wireless Pressure Sensing for Endovascular Leak Detection After Endovascular Thoracic Aneurysm Repair Cyrus J. Parsa, MD, Mani A. Daneshmand, MD, Brian Lima, MD, Keki Balsara, MD, Richard L. McCann, MD, G. Chad Hughes, MD The Annals of Thoracic Surgery Volume 89, Issue 2, Pages 446-452 (February 2010) DOI: 10.1016/j.athoracsur.2009.10.068 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Axial computed tomography angiography images of (A) a “sandwiched” aneurysm sac pressure sensor between stent graft and aortic wall, and (B) a well-positioned sensor with adequate space between the endovascular graft and aortic wall. The sensor in (A) measured systemic transendovascular graft pressure despite successful aneurysm sac exclusion. Arrows depict sensor location. The Annals of Thoracic Surgery 2010 89, 446-452DOI: (10.1016/j.athoracsur.2009.10.068) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Patient allocation: distribution of the 43 patients who received an aneurysm sac pressure sensor in the study interval. The principal indications included atherosclerotic descending thoracic aneurysm and chronic type B dissection with aneurysm (aneurysm sac pressure sensor placed in the aneurysmal false lumen adjacent to covered primary tear). (EL = endovascular leak; TEVAR = thoracic endovascular aortic repair.) The Annals of Thoracic Surgery 2010 89, 446-452DOI: (10.1016/j.athoracsur.2009.10.068) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Pre- and post-exclusion pressure tracings as measured using implanted aneurysm sac pressure (ASP) monitor and external antenna/interrogator. (A) Pre-exclusion ASP reading is taken in the operating room once the device has been placed in the desired intraluminal position within the aneurysm sac, but before stent graft deployment. The pressure tracing indicates an operational EndoSure device with systemic sac pressure readings, including systolic and diastolic pressure, mean arterial pressure, and pulse pressure. (B) Post-exclusion ASP reading indicates diminution in all pressures after stent graft deployment. The ratio of aneurysm sac pulse pressure to a concomitantly obtained systemic pulse pressure measured via arterial line will determine ASP ratio. Tracings provided courtesy of and with reproduction permission of CardioMEMS, Inc. (C) Depiction of a second-generation interrogator with antenna visible (arrow). The antenna is placed externally over the patient's chest to obtain ASP readings. Picture provided courtesy of and with reproduction permission of CardioMEMS, Inc. The Annals of Thoracic Surgery 2010 89, 446-452DOI: (10.1016/j.athoracsur.2009.10.068) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 EndoSure devices. (A) First-generation device. (B) Second-generation EndoSure s2 with two end-loop and basket design abdominal aortic aneurysm pressure sensor. (C) Comparison of the first-generation EndoSure (closest to dime on left) and second-generation device. The difference in length and width is evident. The radiopacity of the second-generation device is also increased. (D) Fluoroscopic image of an in situ device (arrow). (A), (B), and (C) reproduced with the permission of CardioMEMS, Inc. The Annals of Thoracic Surgery 2010 89, 446-452DOI: (10.1016/j.athoracsur.2009.10.068) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Relationship of aneurysm sac pressure and aortic aneurysm diameter. (A) Graphic representation of the ratio of aneurysm sac pressure to systemic pressure at the time of discharge as compared with last clinic follow-up. (B) Graphic representation of the preoperative maximum transverse aortic diameter as compared with last clinic follow-up. *Denotes p < 0.05 in both graphs. (F/U = follow-up.) The Annals of Thoracic Surgery 2010 89, 446-452DOI: (10.1016/j.athoracsur.2009.10.068) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Axial computed tomography angiography image of an aneurysm sac pressure sensor in a thrombosed false lumen after thoracic endovascular aortic repair of a complicated chronic type B dissection with aneurysm. Arrow depicts sensor location. The Annals of Thoracic Surgery 2010 89, 446-452DOI: (10.1016/j.athoracsur.2009.10.068) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions