Abstract 10215: Investigating Aortic Geometric Changes After Endovascular and Open Surgery Repair of Descending Thoracic Aortic Aneurysms

Abstract

Introduction: Repair of descending thoracic aortic aneurysms (DTAA) by endovascular (TEVAR) or open aortic replacement alters aortic anatomical and biomechanical characteristics, which may result in adverse cardiac remodeling. The interplay between all these factors remains mostly unknown. Hypothesis: A robust and objective quantification of 3D geometrical changes to the treated aorta will help investigate long-term cardiovascular consequences of DTAA repair. Methods: Pre- and post-operative 3D modeling from CT angiography was obtained for 6 patients undergoing OPEN (n=3) or TEVAR (n=3). An automated analysis was conducted to extract aorta centerlines, register pre/post geometries based on anatomical landmarks, calculate the following features: length ( L ), curvature ( C ), torsion ( T ), tortuosity ( TT ), cross sectional area ( A ), and volume ( V ). Pre/post repair geometric analysis was conducted on the ascending (AscAo) and descending (DesAo) aorta, and in consecutive segments based on C / T profiles; rotations between segments modeled as osculating planes were calculated; TEVAR vs OPEN differences were investigated. Results: The age of patients was 65±15 years and 4 were female. All centerline and geometric features were calculated from the models. Fig 1 shows one case with registered C profiles. Main results between pre/post were: increase in A AscAo (mean 43.4±20.5 mm 2 ) and V AscAo (mean 31.3±9 cm 3 ); increase in TT DesAo (0.6±0.4 vs 1.4±0.5, p=0.01); TEVAR cases showed DesAo elongation (mean 17.8±4 mm); trends for increasing C max (AscAo) and decreasing C max (DesAo); inter-segment rotations show notable pre/post variations (Fig 1b). Conclusions: Our preliminary analysis automatically quantified relevant changes in aortic anatomy pre/post repair of DTAA with either open or endovascular repair. Complemented with fluid dynamics and biomechanical studies these investigations could clarify mechanisms affecting long-term consequences of DTAA repair.