Aortic Research Articles

Peer Review of “Development and Assessment of a Point-of-Care Application (Genomic Medicine Guidance) for Heritable Thoracic Aortic Disease”

Peer Review of “Development and Assessment of a Point-of-Care Application (Genomic Medicine Guidance) for Heritable Thoracic Aortic Disease”

Peer Review of “Development and Assessment of a Point-of-Care Application (Genomic Medicine Guidance) for Heritable Thoracic Aortic Disease”

Peer Review of “Development and Assessment of a Point-of-Care Application (Genomic Medicine Guidance) for Heritable Thoracic Aortic Disease”

Peer Review of “Development and Assessment of a Point-of-Care Application (Genomic Medicine Guidance) for Heritable Thoracic Aortic Disease”

Peer Review of “Development and Assessment of a Point-of-Care Application (Genomic Medicine Guidance) for Heritable Thoracic Aortic Disease”

Authors’ Response to Peer Reviews of “Development and Assessment of a Point-of-Care Application (Genomic Medicine Guidance) for Heritable Thoracic Aortic Disease”

Authors’ Response to Peer Reviews of “Development and Assessment of a Point-of-Care Application (Genomic Medicine Guidance) for Heritable Thoracic Aortic Disease”

Development and Assessment of a Point-of-Care Application (Genomic Medicine Guidance) for Heritable Thoracic Aortic Disease.

Genetic testing can determine familial and personal risks for heritable thoracic aortic aneurysms and dissections (TAD). The 2022 American College of Cardiology/American Heart Association guidelines for TAD recommend management decisions based on the specific gene mutation. However, many clinicians lack sufficient comfort or insight to integrate genetic information into clinical practice. We therefore developed the Genomic Medicine Guidance (GMG) application, an interactive point-of-care tool to inform clinicians and patients about TAD diagnosis, treatment, and surveillance. GMG is a REDCap-based application that combines publicly available genetic data and clinical recommendations based on the TAD guidelines into one translational education tool. TAD genetic information in GMG was sourced from the Montalcino Aortic Consortium, a worldwide collaboration of TAD centers of excellence, and the National Institutes of Health genetic repositories ClinVar and ClinGen. The application streamlines data on the 13 most frequently mutated TAD genes with 2286 unique pathogenic mutations that cause TAD so that users receive comprehensive recommendations for diagnostic testing, imaging, surveillance, medical therapy, and preventative surgical repair, as well as guidance for exercise safety and management during pregnancy. The application output can be displayed in a clinician view or exported as an informative pamphlet in a patient-friendly format. The overall goal of the GMG application is to make genomic medicine more accessible to clinicians and patients while serving as a unifying platform for research. We anticipate that these features will be catalysts for collaborative projects aiming to understand the spectrum of genetic variants contributing to TAD.

Use of ultra-low contrast dose CT aortography for the management of aortic aneurysmal disease

PurposeComputed tomography aortography (CTA) is used in the assessment of aortic pathologies and planning of surgical intervention. However, its dependence on iodinated contrast can result in development of contrast-induced acute kidney injury (CI-AKI). The potential concern of CI-AKI has spurred research into the potential of administration of low contrast volumes in CTA investigations while maintaining overall diagnostic appeal. Several studies have shown that CTA using contrast volumes as low as 30 mL (equivalent to 10.5 g of iodine) can still yield scans of diagnostic quality. We present a retrospective pilot study to evaluate the feasibility of utilising an ultra-low volume of iodinated intravenous contrast in a population of patients with severe renal insufficiency with referral from our vascular surgery unit for CTA evaluation of the thoracic and abdominal aorta.MethodsThis retrospective pilot study examined 12 CTA scans performed with 20 mLs of iodinated contrast and assessed image quality with both quantitative and qualitative markers. All scans were performed on a Siemens SOMATOM Force dual-source CT scanner. Quantitative assessment values were measured via attenuation values at eight aortoiliac locations and used to calculate a signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) at each location. Qualitative analysis of image quality and viability for surgical intervention was obtained from subjective clinical assessment by an interventional radiologist and vascular surgeon.ResultsObtained quantitative assessment values included mean attenuation 189.9 HU, mean SNR 9.6 and mean CNR 8.0. All 12 scans demonstrated individual mean SNR values above predetermined quality thresholds while only five scans produced individual mean CNR values above threshold. Eleven of 12 scans were determined to be of sufficient quality for diagnosis and planning of surgical intervention.ConclusionsOur results suggest that CTA utilising an ultra-low contrast dose of 20 mLs (6 g iodine) yields scans of diagnostic quality for therapeutic decision-making in vascular surgical intervention.

Tabular review of contemporary fenestrated-branched endovascular aortic repair experiences for treatment of thoracoabdominal aortic aneurysms.

Repair of thoracoabdominal aortic aneurysms (TAAAs) represents a technical challenge regardless of which technique is used. Open surgical repair (OSR) is the time-tested option against which novel techniques must be compared and it is still considered the gold standard option for younger, fit patients with heritable aortic diseases. Endovascular repair offers a less-invasive alternative in patients with suitable anatomy. This article aims to present a tabular review of the contemporary published data on endovascular repair of TAAAs using fenestrated-branched techniques. The published literature for single-center and multicenter studies evaluating the outcomes of FB-EVAR for TAAAs was searched using MEDLINE and Embase databases. Studies published between January 1st 2010 and July 11th 2024, in the English language which provided data on FB-EVAR of TAAAs with more than fifty reported cases were included. The average patient age at time of repair was 71 years old with majority of males (65.5%). Most patients presented with a Crawford Extent II TAAAs (21.6%), followed by Extent III (21.2%). Early mortality was 4.9% for the entire cohort. The most prevalent adverse event was acute kidney injury (9.4%), followed by spinal cord injury (8.0%). FB-EVAR of TAAAs continues to evolve. Pooled analysis of early mortality and morbidity is lower in this tabular review than historical outcomes of open TAAA repair.

Beyond the root: Geometric characterization for the diagnosis of syndromic heritable thoracic aortic diseases

Syndromic heritable thoracic aortic diseases (sHTAD), such as Marfan (MFS) or Loeys–Dietz (LDS) syndromes, involve high risk of life threatening aortic events. Diagnosis of syndromic features alone is difficult, and negative genetic tests do not necessarily exclude a genetic or hereditary condition. Periodic 3D imaging of the aorta is recommended in patients with aortic disease. Thus, an imaging-based approach aimed at identifying unique features of aortic geometry can be highly effective for diagnosing sHTAD and assessing risk. In this study, we present a method that can help identify the manifestations of sHTAD by focusing on the entire geometry of the thoracic aorta, rather than only using measurements of dilation of the aortic root. We analyze the geometric phenotype of 97 patients with genetically confirmed sHTAD (79 MF and 18 LDS) and of 45 healthy volunteers, using 3D aorta meshes obtained from phase contrast-enhanced magnetic resonance angiograms computed from 4D flow cardiac magnetic resonance. We build a geometric encoding of the aorta, based on a vessel coordinate system, and use several mathematical models to discriminate between controls and patients with sHTAD: a baseline scenario, based on aortic root dimensions only, a descriptor typically used in sHTAD patients; a low dimensional scenario, with a reduce encoding using principal component analysis; and a high-dimensional scenario, which included the full coefficient representation for geometry encoding, aiming to capture finer geometric details. The results indicate that considering the anatomy of the whole thoracic aorta can improve predictive ability. We achieve precision and sensitivity values over 0.8, with a specificity of over 70% in all the models used, while a single value classifiers (based only on aortic root diameter) demonstrated a trade-off between sensitivity and specificity. Using the mathematical properties of the vessel coordinate system representation, feature importance is mapped onto a set of anatomical traits that are used by the models to do the classification, thus providing interpretability of the results. This analysis indicates that in addition to the diameter of the aortic root, aortic elongation and a narrowing of the descending thoracic aorta may be markers of positive sHTAD.

Inhibition of poly(ADP-Ribosyl)ation reduced vascular smooth muscle cells loss and improves aortic disease in a mouse model of human accelerated aging syndrome

Hutchinson-Gilford progeria syndrome (HGPS) is an extremely rare genetic disorder associated with features of accelerated aging. HGPS is an autosomal dominant disease caused by a de novo mutation of LMNA gene, encoding A-type lamins, resulting in the truncated form of pre-lamin A called progerin. While asymptomatic at birth, patients develop symptoms within the first year of life when they begin to display accelerated aging and suffer from growth retardation, and severe cardiovascular complications including loss of vascular smooth muscle cells (VSMCs). Recent works reported the loss of VSMCs as a major factor triggering atherosclerosis in HGPS. Here, we investigated the mechanisms by which progerin expression leads to massive VSMCs loss. Using aorta tissue and primary cultures of murine VSMCs from a mouse model of HGPS, we showed increased VSMCs death associated with increased poly(ADP-Ribosyl)ation. Poly(ADP-Ribosyl)ation is recognized as a post-translational protein modification that coordinates the repair at DNA damage sites. Poly-ADP-ribose polymerase (PARP) catalyzes protein poly(ADP-Ribosyl)ation by utilizing nicotinamide adenine dinucleotide (NAD+). Our results provided the first demonstration linking progerin accumulation, augmented poly(ADP-Ribosyl)ation and decreased nicotinamide adenine dinucleotide (NAD+) level in VSMCs. Using high-throughput screening on VSMCs differentiated from iPSCs from HGPS patients, we identified a new compound, trifluridine able to increase NAD+ levels through decrease of PARP-1 activity. Lastly, we demonstrate that trifluridine treatment in vivo was able to alleviate aortic VSMCs loss and clinical sign of progeria, suggesting a novel therapeutic approach of cardiovascular disease in progeria.

Comments on the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases

Comments on the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases

Evaluation of Effectiveness of Thoracic Endovascular Treatment for Infectious Aortic Diseases

PurposeTo investigate the effectiveness of thoracic endovascular aortic repair (TEVAR) for infectious aortic diseases. Materials and MethodsPatients who underwent TEVAR for infectious aortic diseases including infected thoracic aortic aneurysm, aortobronchial fistula (ABF), and aortoenteric fistula from December 2011 to October 2022 at 4 institutions were retrospectively studied. The primary outcome of the study was overall survival, whereas the secondary outcome was comprehensive adverse events. Comprehensive adverse events were defined as a combination of deaths, aortic events, and infectious adverse events. ResultsA total of 28 patients were included in the analysis, with 13 patients having infected thoracic aortic aneurysms, 12 ABFs, and 3 aortoenteric fistulae. Seven patients (25%) underwent additional procedures (abscess drainage, 6 cases; total esophagectomy, 1 case). The mean follow-up period was 30.0 months (SD ± 33.9). The 1-year and 5-year survival rates were 85.7% and 67.9%, respectively. The 1-year and 5-year aorta-related complication-free survival rates were 64.3% and 42.9%, respectively. On univariate analysis, the presence of an ABF was associated with a higher risk of comprehensive adverse events (odds ratio = 11; P = .04). ConclusionsTEVAR might be a promising treatment for infectious thoracic aortic diseases. Among the infectious pathologies, ABF was considered ominous in terms of late outcomes.

Clinically Relevant Extracardiac Findings at Cardiac Imaging: Insights from the European MR/CT Registry.

Purpose To determine the prevalence of clinically relevant extracardiac findings at cardiac CT and MRI examinations from a multicenter, multinational MR/CT registry and the relationship of prevalence with examination indications and patient characteristics. Materials and Methods This was a retrospective analysis of data from the European Society of Cardiovascular Radiology MR/CT Registry. Data from 208 506 cardiac CT examinations (median patient age, 66 years [IQR, 55-77]; 121 617 [58.33%] male patients) and 228 462 cardiac MRI examinations (median patient age, 57 years [IQR, 42-69]; 145 792 [63.81%] male patients) entered into the registry between January 2011 and November 2023 were analyzed. Clinically relevant extracardiac findings were defined as findings requiring follow-up examinations or influencing clinical management. The association of examination indication and patient characteristics, including age, with prevalence of extracardiac findings was evaluated using incidence rate ratios (IRRs) derived from multivariable Poisson regression models. Results The prevalence of clinically relevant extracardiac findings was 3.28% (6832 of 208 506) at cardiac CT and 1.50% (3421 of 228 462) at cardiac MRI examinations. Extracardiac findings were more common at CT examinations performed for transcatheter aortic valve replacement (IRR, 2.07; P < .001) and structural heart disease (IRR, 1.44; P < .001) compared with CT performed for coronary artery disease (IRR, 1; reference). Extracardiac findings were more common at MRI examinations performed for myocarditis (IRR, 1.36; P < .001) and structural heart disease (IRR, 1.16; P < .001) than for coronary artery disease. Older patient age was also significantly associated with higher prevalence of extracardiac findings, with an IRR for both CT and MRI examinations of 1.02 (P < .001). Conclusion Data from the multicenter, multinational MR/CT registry indicate that clinically relevant extracardiac findings are present at cardiovascular CT and MRI examinations, and the prevalence of these findings is associated with examination indication and patient age. Keywords: Cardiac Imaging Techniques, Incidental Findings, MRI, CT Angiography, CT, Heart Disease Supplemental material is available for this article. © RSNA, 2024.

Atrial septal pouch in cats: first report on interatrial septum anatomical variations.

The atrial septal pouch was first recognised in humans in 2006 and, since 2010, has been described in more detail. The first reports on the left-sided atrial septal pouch linked its occurrence with a higher risk of thromboembolic stroke resulting from left atrial thrombus formation. However, subsequent studies have challenged this theory; therefore, the consequences of septal pouch occurrence remain disputed. Currently, in veterinary species, septal pouch occurrence and morphology have been described in sheep and pigs, showing species-related differences. No studies have been conducted on cats. As cats show a species-related risk of aortic thromboembolic disease resulting from left atrial thrombus formation, we aimed to describe the interatrial septum anatomical variations as the first step in the investigation of the relationship between the septal pouch presence and left atrial thrombus formation. The study was conducted on hearts collected post mortem from 80 cats. After formalin fixation and dissection, a detailed anatomical description of the interatrial septum for all cases was followed by a histopathological analysis of the heart in 25 cases. After dissection, the specimens were embedded in paraffin blocks and stained with haematoxylin and eosin, Masson-Goldner trichrome, Picrosirius Red and Movat pentachrome in a routine manner and evaluated via light microscopy. Our study showed a very high prevalence (95%) of the left-sided septal pouch in cats with a lower incidence (29%) of the right-sided septal pouch. We noted a high morphological variety of the left-sided septal pouch and described anatomical variants not previously reported in the literature. The septal pouch is a common anatomical variation of the interatrial septum in cats. Although, based on the current study, we cannot draw further conclusions on the relationship between the left-sided septal pouch and thromboembolic events in cats, the high prevalence of this anatomical entity points to a need of further studies on the topic.

Clinical impact of proximal fixation augmentation using the Najuta thoracic fenestrated stent graft during endovascular treatment for distal aortic arch aneurysm

ObjectivePrevention of late type 1a endoleaks is the main concern in thoracic endovascular aortic aneurysm repair (TEVAR) for thoracic aortic aneurysm (TAA). Since 2017, we have performed zone 0 TEVAR with proximal fixation augmentation using a Najuta thoracic fenestrated stent graft in addition to zone 2 TEVAR for distal arch aneurysms. We report the early-midterm outcomes of TEVAR performed using this strategy. MethodsThis single-center retrospective study enrolled 386 cases of TEVAR for thoracic aortic disease between January 2013 and December 2020. Patients with TAA treated by TEVAR landing at zone 2 was referred to as the Standard group (S group), whereas those treated by TEVAR landing at zone 0 using a Najuta fenestrated stent graft in addition to zone 2 TEVAR was referred to as the Augmentation group (A group). We retrospectively compared the clinical outcomes between the two groups. The primary endpoint was secondary intervention for postoperative type1a endoleaks. Secondary endpoints were technical success, aneurysm-related death (ARD), and major adverse events (MAEs) including stroke, paraplegia, endoleaks, and secondary interventions. ResultsWe performed TEVAR in 41 and 30 cases in the S and A groups, respectively. The mean aneurysm sizes in the S and A group were 54.5 and 57.3 mm (p=0.23), and the proximal neck lengths were 16.8 and 17.4 mm (p = 0.65), respectively. The anatomical characteristics appeared to be similar in both groups. The technical success rate in both groups was 100%. Three cases in the S group had MAEs, including two stroke and one brachial artery pseudoaneurysm; whereas, 2 cases had MAEs in the A group, including one stroke and one paraplegia. There was no 30-day mortality or retrograde type A dissection in both groups. The mean observation periods in the S and A groups were 46 (1–123) and 35 (1–73) months, respectively. At 36 and 60 months post-procedure, the freedom from ARD was 97.6% and 97.6% in the S group, 100.0% and 100.0% in the A group (p=0.39); and the freedom from re-intervention for type1a endoleaks was 79.2% and 65.2% in the S group, 100.0% and 100.0% in the A group (p = 0.0087 < 0.05). A statistically significant reduction in re-intervention for type1a endoleaks was observed in the A group. ConclusionsProximal fixation augmentation using the Najuta fenestrated stent graft during TEVAR for distal arch aneurysm is effective in preventing the postoperative late type 1a endoleaks.

Laser Fenestration for Complex Aortic Repair: Versatile Option in Difficult Anatomy, Emergencies and Bailouts

BackgroundBranched and fenestrated endovascular aortic repair (b/fEVAR) for thoracoabdominal aortic disease as well as thoracic disease (b/fTEVAR) has been well described. Its utilization has also grown over time with the need for solutions having outpaced technologies available in the United States. As more practitioners utilize these and other complex aortic repairs there is a growing utilization of adjunctive modalities expanding the capabilities of current devices. In-situ fenestration (ISF) has arisen as one of those modalities for both vessel fenestration and endoleak repair. ISF has been described for its role in bailout of thoracic endovascular aortic repair (TEVAR) particularly in fenestration for the left subclavian artery, but has not been well described in b/fEVAR in respect to the visceral vessels with most data limited to case series. We sought to review our single institution experience with this technique. MethodsSingle institution retrospective review of ISF during initial b/fEVAR, TEVAR from 2020 to 2022. Laser fenestrations post original b/fEVAR or TEVAR for endoleak repair were also included. Perioperative outcomes were obtained as well as angiographic results and short -term results found on follow up CT scans per SVS guidelines. Detailed operative techniques are discussed. ResultsA total of 13 patients were identified with 17 laser fenestrations. 11 ISF were planned preoperatively and 2 were intra-op decisions. The indications for surgery were type B aortic dissection with malperfusion (3), thoracoabdominal aortic aneurysm (TAAA): Non-ruptured (7), Ruptured (1), Type III endoleak post b/EVAR (1) and Type IA endoleak s/p fEVAR (1). Laser fenestration was used in conjunction of 3 TEVAR and 10 (b/fEVAR). The distribution of vessels fenestrated was: 5 left renal artery (LRA), 5 right renal artery (RRA), 4 left subclavian artery (LSCA), 1 superior mesenteric artery (SMA), 1 Celiac. Technical success was achieved in all 17 fenestrations with no 30-day mortalities, no post op dissection or spinal cord ischemia. There were 3 cases of endoleak at the completion of the operation, 1 type II and 1 type IIIc. ConclusionISF of aortic stent grafts in b/fEVAR and TEVAR is useful as a bailout in complex aortic repair with high likelihood of technical success and low morbidity.

Exercise, Sports Participation, and Quality of Life in Young Patients with Heritable Thoracic Aortic Disease.

Patients with heritable thoracic aortic disease (HTAD)are often restricted from sports and certain types of exercise. This study was designed to investigate the effect of lifetime exercise exposure and competitive sports participation on quality of life (QOL) in patients aged 15-35 with syndromic [Marfan syndrome (MFS), Loeys-Dietz syndrome (LDS), vascular Ehlers-Danlos syndrome (vEDS)] and non-syndromic heritable thoracic aortic disease (nsHTAD). This cross-sectional study employed questionnaires to assess lifetime exercise exposure and utilized the PedsQL QOL Inventory. We developed an Exercise Exposure Score (EES) to quantify lifetime exercise exposure. Questionnaires were completed via telephone with complimentary medical record review. Forty patients were enrolled. Mean age was 26 years. The diagnosis was MFS in 83%. Despite 88% of patients being restricted by their provider, 65% reported competitive sports participation and 93% reported recreational exercise. Participants with an EES greater than the median had significantly better total QOL scores compared to those below the median (78 vs 65, p = 0.03). There were significant positive correlations between current frequency of exercise and psychosocial QOL (slope = 3.9, 95% CI: (1.2, 6.6), p = 0.005), physical QOL (slope = 8.1, 95% CI: (4.1, 12), p < 0.001), and total QOL score (slope = 6.0, 95% CI: (3.1, 9.0), p < 0.001). We found no difference in aortic size or need for surgical intervention between those above and below the median EES, or between those who did and did not participate in competitive sports. Despite exercise restrictions, young HTAD patients are physically active. Increased lifetime exercise and current physical activity levels were associated with improved QOL in HTAD patients.

Long-term outcomes of frozen elephant trunk for aortic dissection: a single-center experience

BackgroundTo date a number of papers analysing outcomes of the frozen elephant trunk (FET) in acute aortic dissection has been published. However, there are limited comparative studies on long-term outcomes of FET in acute and chronic aortic dissection. The objective of the study was to analyze the long-term outcomes after FET procedure for aortic dissection (AD).MethodsBetween March 2012 and December 2022, a total of 123 FET had been performed for thoracic aortic disease. Patients with aortic dissection (n = 97) were divided into 2 groups: acute (n = 32, 33%) and chronic aortic dissection (n = 65, 67%). Pre-, intra- and postoperative data were retrospectively collected from electronic patient’s records, including follow-up data of the analyzed patients.ResultsThe incidence of stroke was 3.1%. The delirium rate was up to 9.3% in both groups with a prevalence in chronic aortic dissection (CAD) group without significant differences (P = 0.494). Paraplegia was diagnosed only in CAD patients (n = 2). Respiratory failure and the rate of renal replacement therapy were similar in the studied groups. Re-sternotomy was required in one (3.1%) patient with acute AD and 5 (7.7%) patients with chronic AD (P = 0.416). Overall 30-day mortality in the entire cohort, acute and chronic AD was 13 (13.4%), 7 (21.9%) and 6 (9.2%), respectively (P = 0.097). The overall survival rate at 60 months for the entire cohort, acute and chronic AD was 64.1 ± 5.9%, 62.3 ± 9.1%, 66.5 ± 7%, respectively (P = 0.265). Freedom from unintended distal aortic re-intervention at 60 months for the entire cohort of patients, acute and chronic AD was 74.2 ± 1.5%, 100%, 65.3 ± 2%, respectively (P = 0.355).ConclusionsOur experience showed acceptable long-term outcomes after the FET procedure including mortality and re-intervention rate in patients with aortic dissection regardless of acuity of the dissection.Trial registrationThe study has been registered in Australian and New Zealand Clinical Trial Registry (ACTRN 12618001329257) on August 7, 2018.

Physician-Modified and In Situ Fenestrated Stent Grafts in Zone 0 for Aortic Arch Pathology After Ascending Aortic Replacement.

We sought to describe our experience and outcomes of a zone 0 landing physician-modified aortic stent for the treatment of aortic arch pathologies late after open ascending aortic replacement. This study included consecutive patients with aortic arch diseases treated with total endovascular repair using different techniques. The indication for endovascular repair was agreed on in a multidisciplinary discussion. Study end points were technical success, early and late outcomes. From November 2018 to May 2022, 16 consecutive patients underwent total endovascular repair of aortic arch pathologies. Median time for surgery was 4.8 hours (range, 2.6-6.6 hours). All the new-onset aortic arch pathologies were successfully treated. The 30-day mortality rate was 0%. Two patients had endoleak. The median length of postoperative stay was 4 days (range, 3-6 days). During follow-up, 1 patient underwent reintervention for type II endoleak. There were no conversions to retrograde dissection, aortic rupture and stroke. Our experience of using different total endovascular techniques for selective patients with arch pathologies who may be unfit or too risky for reopen surgery revealed favorable initial results. In addition, these techniques are promising options for urgent arch pathologies without availability of custom-manufactured devices. Durability concerns will need to be assessed in additional studies with long-term follow-up. The use of physician-modified and in situ fenestrated stent grafts in zone 0 landing for aortic arch pathologies in patients with prior open ascending aortic replacement is effective in endovascular therapy. This innovation enables clinicians to offer an alternative option to high-risk patients, potentially reducing morbidity and mortality. It underscores the feasibility of tailored endovascular therapy in complex aortic diseases, where customized devices may not be available.

Temporal geometric mapping defines morphoelastic growth model of Type B aortic dissection evolution

The human aorta undergoes complex morphologic changes that mirror the evolution of disease. Finite element analysis (FEA) enables the prediction of aortic pathologic states, but the absence of a biomechanical understanding hinders the applicability of this computational tool. We incorporate geometric information from computed tomography angiography (CTA) imaging scans into FEA to predict a trajectory of future geometries for four aortic disease patients. Through defining a geometric correspondence between two patient scans separated in time, a patient-specific FEA model can recreate the deformation of the aorta between the two time points, showing that pathologic growth drives morphologic heterogeneity. FEA-derived trajectories in a shape-size geometric feature space, which plots the variance of the shape index versus the inverse square root of aortic surface area (δS vs. AT−1), quantitatively demonstrate an increase in δS. This represents a deviation from physiologic shape changes and parallels the true geometric progression of aortic disease patients.

An analysis of early and long-term gender-related outcomes after thoracic endovascular aortic repair.

To evaluate gender-related outcomes during endovascular treatment of thoracic and thoraco-abdominal aortic diseases (TEVAR). Multicentre, retrospective, observational cohort study. All TEVARs between January 2005 and April 2023 were identified. Primary outcomes were 30-day mortality, and cumulative survival. Secondary outcomes were vascular access complications, and freedom from TEVAR-related reintervention. Interventions performed in male patients were matched to females on the basis of a one-to-one coarsened exact matching. We identified 151 males who were matched with 151 females. Mortality at 30-day was not statistically different between females and males (11.2% vs 11.2%, P = 1.0). At binary logistic regression analysis, duration of intervention (P = 0.001), and emergency TEVAR (P = 0.001) were associated with mortality at 30 days. Gender did not impact access vessel complication rate [n = 6 (4.0%) vs n = 5 (3.3%), P = 1.0]. The median of follow-up was 46 (IQR, 7-84) months with no difference between males and females [median, 50 (11-95) vs 37.5 (3.5-71.2); P = 0.153]. Estimated survival was not statistically different between females and males (Log-rank χ2 = 0.6, P = 0.442; 95% CI: 110.7-207.3). At Cox's regression analysis, gender did not impact overall survival (HR: 0.8, 95% CI: 0.6-1.3, P = 0.450). Estimated freedom from TEVAR-related reinterventions was not statistically different between females and males (Log-rank χ2 = 0.4, P = 0.837; 95% CI: 187.8-219.3). Female gender itself was not associated with worse 30-day mortality and late survival than males with similar access vessel complication as well as TEVAR-related reintervention rate.