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Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection

World Journal of Surgery volume 44, pages 1323–1330 (2020)Cite this article

Abstract

Objective

Tortuosity in the descending thoracic aorta (DTA) comes with aging and increases the risk of endoleaks after TEVAR. With this report, we would like to define and classify tortuosity in the DTA of patients with thoracic aortic disease.

Methods

Retrospective case–control study of two hundred seven patients, comparing sixty-nine controls without aortic disease (CG), to sixty-nine patients with descending thoracic aortic aneurysm (AG) and sixty-nine patients with type B aortic dissection (DG). 3Mensio Vascular software was used to analyze CTA scans and collect the following measurements; tortuosity index, curvature ratio and the maximum tortuosity of the DTA. The DTA was divided into four equal zones. The maximum tortuosity was divided into three groups: low (<30°), moderate (30°–60°) and high tortuosity (>60°).

Results

Compared to the CG, tortuosity was more pronounced in the DG, and even more in the AG, evidenced by the tortuosity index (1.11 vs. 1.20 vs. 1.31; p < 0.001), curvature ratio (1.00 vs. 1.01 vs. 1.03; p < 0.001), maximum tortuosity in degrees (28.17 vs. 33.29 vs. 43.83; p < 0.001) and group of tortuosity (p < 0.001). The maximum tortuosity was further distal for the DG and AG, evidenced by the zone of maximum tortuosity (4A vs. 4B vs. 4B; p < 0.001).

Conclusion

This study shows that tortuosity in the DTA is more prominent in diseased aortas, especially in aneurysmal disease. This phenomenon needs to be taken into account during planning of TEVAR to prevent stent graft-related complications and to obtain positive long-term outcome.

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Fig. 1

Reprinted from Belvroy et al. published by PLOSONE, open access journals [11]

Fig. 2

Reprinted from Belvroy et al. published by PLOSONE, open access journals [11]

Fig. 3

Reprinted from Belvroy et al. published by PLOSONE, open access journals [11]

Fig. 4
Fig. 5

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Funding

The authors declare that they have not received funding.

Author information

Affiliations

  1. Thoracic Aortic Research Center, IRCCS Policlinico San Donato, Piazza Malan 2, 20097, San Donato Milanese, Italy

    Viony M. Belvroy & Hector W. L. de Beaufort

  2. Department of Vascular Surgery, University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Viony M. Belvroy, Hector W. L. de Beaufort, Joost A. van Herwaarden & Frans L. Moll

  3. Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St, Houston, TX, 77030, USA

    Viony M. Belvroy & Jean Bismuth

  4. Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Viale Luigi Borri 57, 21100, Varese, Italy

    Gabriele Piffaretti

  5. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan, Via Della Commenda 10, 20122, Milan, Italy

    Santi Trimarchi

  6. Department of Clinical and Community Science, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy

    Santi Trimarchi

Authors
  1. Viony M. Belvroy
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  2. Hector W. L. de Beaufort
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  3. Joost A. van Herwaarden
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Correspondence to Viony M. Belvroy.

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Belvroy, V.M., de Beaufort, H.W.L., van Herwaarden, J.A. et al. Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection. World J Surg 44, 1323–1330 (2020). https://doi.org/10.1007/s00268-019-05328-w

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  • DOI: https://doi.org/10.1007/s00268-019-05328-w