Thoracic endovascular aortic repair (TEVAR) can change the morphology of the flow lumen in aortic dissections, which could affect aortic hemodynamics and function. The present study characterized how the helical morphology of the true lumen in type B aortic dissections is altered by TEVAR. Patients with type B dissection who had undergone computed tomography angiography before and after TEVAR were retrospectively recruited. The images were used to construct three-dimensional stereolithographic surface models of the true lumen and whole aorta using custom software (Fig 1). The stereolithographic models were segmented and co-registered to determine the helicity of the true lumen with respect to the whole aorta. The helical angle, helical radius, helicity (change of the helical angle over 3 cm using a sliding window), and cross-sectional eccentricity and area were quantified for the true lumen region covered by the endograft before and after TEVAR (Fig 1). Two-tailed paired t tests were used to compare the pre- and post-TEVAR metrics. Twelve patients (age, 61.75 ± 7.74 years; 8.3% women) had been treated successfully for complicated type B dissection with TEVAR (C-TAG; WL Gore & Associates, Newark, Del). From before to after TEVAR, the true lumen helical angle (−63° ± 70− to −58° ± 72°; P = .732) and peak helicity (−16° ± 15°/cm to −19° ± 12°/cm; P = .237) did not change significantly (Fig 2 and the Table). Both the true lumen average helical radius (1.37 ± 0.49 cm to 0.96 ± 0.55 cm; P = .001) and eccentricity (0.84 ± 0.15 to 0.66 ± 0.15; P = .002) had significantly decreased from before to after TEVAR. In contrast, the average cross-sectional area had increased significantly (from 3.22 ± 1.00 cm2 to 4.59 ± 1.58 cm2; P = .014). The unchanged helical angle and peak helicity as a result of TEVAR suggest that the proximal and distal portions of the region of interest were constrained to angular positions and the endografts used to treat this cohort were helically conformable in the angular direction. The decrease of the average helical radius indicated a straightening of the “corkscrew” shape of the true lumen, which might affect hemodynamics and aortic tissue stress. The effect of TEVAR on dissection flow lumen morphology and the interaction between endografts and aortic tissue will provide useful information for improving device design, implantation techniques, and long-term clinical outcomes.Fig 2Graph displaying how the helical angle, helical radius, true lumen eccentricity, and true lumen area vary longitudinally and how they are altered by thoracic endovascular aortic repair (TEVAR) for an example patient.View Large Image Figure ViewerDownload Hi-res image Download (PPT)TableQuantified metrics in region of interest before and after TEVARVariableBefore TEVARAfter TEVARP valueHelical angle, °−63 ± 70−58 ± 72.732Peak helicity, °/cm−16 ± 15−19 ± 12.237Average helical radius, cm1.37 ± 0.490.96 ± 0.55.001Average true lumen eccentricity0.84 ± 0.150.66 ± 0.15.002Average true lumen area, cm23.22 ± 1.004.59 ± 1.58.014TEVAR, Thoracic endovascular aortic repair.Boldface P values represent statistical significance. Open table in a new tab