Thoracic Aorta Research Articles

CT-based multi-regional radiomics model for predicting contrast medium extravasation in patients with tumors: A case-control study.

To develop a non-contrast CT based multi-regional radiomics model for predicting contrast medium (CM) extravasation in patients with tumors. A retrospective analysis of non-contrast CT scans from 282 tumor patients across two medical centers led to the development of a radiomics model, using 157 patients for training, 68 for validation, and 57 from an external center as an independent test cohort. The different volumes of interest from right common carotid artery/right internal jugular vein, right subclavian artery/vein and thoracic aorta were delineated. Radiomics features from the training cohort were used to calculate radiomics scores (Rad scores) and develop radiomics model. Non-contrast CT radiomics features were combined with clinical factors to develop an integrated model. A nomogram was created to visually represent the integration of radiomic signatures and clinical factors. The model's predictive performance and clinical utility were evaluated using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA), respectively. Calibration curves were also used to assess the concordance between the model-predicted probabilities and the observed event probabilities. Thirteen radiomics features were selected to determine the Rad score. The radiomic model outperformed the clinical model in the training, validation, and external test cohorts, achieving a greater area under the ROC curve (AUC) with values of 0.877, 0.866, 0.828 compared to the clinical model's 0.852, 0.806, 0.740. The combined model yielded better AUC of 0.945, 0.911, and 0.869 in the respective cohorts. The nomogram identified females, the elderly, individuals with hypertension, long term chemotherapy, radiomic signatures as independent risk factors for CM extravasation in patients with tumors. Calibration and DCA validated the high accuracy and clinical utility of this model. Radiomics models based on multi-regional non-contrast CT image offered improved prediction of CM extravasation compared with clinical model alone.

Combination of the LPS/TLR4 Pathway and Fecal Metabolomics Analysis Reveals the Chronic Inflammatory Mechanism of Early Atherosclerosis in Tibetan Miniature Pigs

Abstract Objective: This study aimed to elucidate the effect of the lipopolysaccharides/toll-like receptor 4 (LPS/TLR4) pathway on early atherosclerosis (AS) development and its associated changes in fecal metabolites, thereby providing an experimental foundation for strategies to prevent and treat early AS. Methods: Twelve Tibetan miniature pigs aged 4–5 months were divided into normal control (NC) group and AS group (6 pigs in each). The group assignment was primarily based on body weight; Secondary criteria, including glucose, lipid profiles, and inflammatory indices, were considered to ensure balanced baseline characteristics between the 2 groups (all P > 0.05). AS group received a high-fat diet for 16 weeks to establish an AS model, while the NC group received a normal diet. Subsequently, serum levels of lipids and various inflammation and oxidative stress markers were measured. Pathological changes in the aorta and colon tissue, LPS/TLR4 pathway-associated protein expressions in the aorta, as well as occludin and zonula occludens-1 in the colon were also assessed. Proton nuclear magnetic resonance spectra technology was employed for the metabolomic analysis of fecal extracts. Results: The lipid metabolism was disrupted in AS group, with significantly higher total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol levels ((12.24 ± 5.24) mmol/L vs. (1.86 ± 0.27) mmol/L, P = 0.004,6; (2.39 ± 0.50) mmol/L vs. (0.83 ± 0.07) mmol/L, P = 0.000,5; (6.94 ± 2.87) mmol/L vs. (0.77 ± 0.18) mmol/L, P = 0.003,3), as compared to that in NC group. Serum factors, including LPS, tumor necrosis factor-α, and malondialdehyde levels of AS group were significantly higher than that of NC group ((1,230.00 ± 192.70) EU/L vs. (695.70 ± 213.70) EU/L), P = 0.001,1; (424.20 ± 176.90) ng/L vs. (51.20 ± 26.61) ng/L, P = 0.023,5; (3.60 ± 0.77) nmol/mL vs. (2.62 ± 0.21) nmol/mL, P = 0.025,4). Pathological evaluations revealed prominent lipid deposition area in the aortic arch, thoracic aorta, and abdominal aorta of the AS group compared with that of the NC group (4.17% ± 2.30% vs 0, P = 0.006,7; 6.23% ± 2.95% vs 0, P = 0.003,6; 3.78% ± 2.18% vs 0, P = 0.008,1). TLR4, nuclear factor kappa-B p65, and tumor necrosis factor-α expression in the aorta tissue of the AS group were upregulated, whereas occludin and zonula occludens-1 expression in colon tissues was downregulated. Additionally, metabolomics identified significant differences in 21 metabolites in the feces of the AS group compared to the NC group, with further analysis linking these differences to amino acid metabolism. Conclusions: The Tibetan miniature pig model of early AS induced by high-fat intake displayed pronounced chronic inflammation. Preliminary findings suggest that the underlying mechanisms may be associated with the LPS/TLR4 pathway and intestinal metabolic disorders.

Case report and literature review: fetal diagnosis of vascular ring with circumflex right aortic arch and unique aortic arch branching pattern

Circumflex right aortic arch is a rare aortic arch anomaly where the arch extends in a retro-esophageal pattern with a left-sided descending thoracic aorta. In the setting of circumflex right aortic arch with the ductus arteriosus connecting the left descending aorta and left pulmonary artery, a vascular ring is present and can cause compressive symptoms of the aerodigestive tract. A 33-year-old G4P3 patient underwent fetal echocardiography after obstetric ultrasound showed concern for double aortic arch. Fetal echocardiogram was suspicious for vascular ring with presumptive diagnosis of double aortic arch vs. circumflex right aortic arch. The child was born at 38 weeks gestation via induced vaginal delivery and had an uneventful postnatal course. Post-natal echocardiogram was able to diagnose vascular ring but could not fully assess the arch or branching pattern. Cardiac computed tomography angiography (CCTA) was able to definitively diagnose right aortic arch and characterize the branching pattern. To our knowledge, this is the first case reported in the literature of a circumflex right aortic arch suspected on fetal echocardiogram and postnatal echocardiogram and subsequently confirmed with CCTA. Fetal echocardiogram provides a unique opportunity to assess the aortic arch as the trachea is filled with fluid. However, circumflex aortic arch and double aortic arch can be difficult to delineate on fetal or post-natal echocardiography. CCTA is an effective modality for evaluation of the aortic arch and its branching pattern in the setting of non-diagnostic echocardiography.

Gastrointestinal Complications and Laparotomy after Cardiac Surgery: A Retrospective Cohort Study

AIM: Gastrointestinal (GI) complications following cardiac surgery are infrequent, but associated with high rates of postoperative mortality. The aim of our study was to identify risk factors predisposing patients to GI complications following cardiac surgery and describe the outcomes of patients suffering a GI complication. METHODS: This was a retrospective cohort study of 6769 consecutive patients undergoing cardiac surgeries (at least one of coronary artery bypass grafting (CABG), aortic valve replacement, mitral valve replacement, or surgery on thoracic aorta) at a single Scottish centre between 1 January 2015 and 27 September 2023. Cohort demographics, intra-operative details and postoperative outcomes were compared between patients who did and who did not experience a gastrointestinal GI complication. RESULTS: Patients who experienced a GI complication had greater rates of thirty-day mortality (14.4% vs 2.4%, p < 0.001) and in-hospital mortality (6.8% vs 1.1%, p < 0.001) compared with those who did not. We identified previous percutaneous coronary intervention (PCI) (Odds ratio (OR) 2.27 [1.24–4.17], p = 0.007) and combined cardiac surgery (OR 1.67 [1.02–2.74], p = 0.043) as two risk factors for developing a GI complication, in addition to several previously identified risk factors (postoperative atrial fibrillation, postoperative vascular complication, use of pre-operative inotropes and increased age). CONCLUSIONS: GI complications frequently occur in elderly, co-morbid patients and in conjunction with other complications. Particularly lethal are mesenteric ischemia, GI bleeding, and small bowel obstruction. Extra caution should be observed in the patient group undergoing more than one cardiac procedure or those with a prior history of coronary artery disease. Prompt emergency laparotomy is a potentially life-saving intervention in promptly diagnosed patients, but confers a high risk of intra-operative and thirty-day mortality.

Determinants of ascending aortic morphology: Cross-sectional deep learning-based analysis on 25,073 non-contrast-enhanced NAKO MRI studies.

Understanding determinants of thoracic aortic morphology is crucial for precise diagnostics and therapeutic approaches. This study aimed to automatically characterize ascending aortic morphology based on 3D non-contrast-enhanced magnetic resonance angiography (NC-MRA) data from the epidemiological cross-sectional German National Cohort (NAKO) and to investigate possible determinants of mid-ascending aortic diameter (mid-AAoD). Deep learning (DL) automatically segmented the thoracic aorta and ascending aortic length, volume, and diameter was extracted from 25,073 NC-MRAs. Statistical analyses investigated relationships between mid-AAoD and demographic factors, hypertension, diabetes, alcohol, and tobacco consumption. Males exhibited significantly larger mid-AAoD than females (M:35.5±4.8mm, F:33.3±4.5mm). Age and body surface area (BSA) were positively correlated with mid-AAoD (age: male: r²=0.20, p<0.001, female: r²=0.16, p<0.001; BSA: male: r²=0.08, p<0.001, female: r²=0.05, p<0.001). Hypertensive and diabetic subjects showed higher mid-AAoD (ΔHypertension = 2.9 ± 0.5mm; ΔDiabetes = 1.5 ± 0.6mm). Hypertension was linked to higher mid-AAoD regardless of age and BSA, while diabetes and mid-AAoD were uncorrelated across age-stratified subgroups. Daily alcohol consumption (male: 37.4±5.1mm, female: 35.0±4.8mm) and smoking history exceeding 16.5 pack-years (male: 36.6±5.0mm, female: 33.9±4.3mm) exhibited highest mid-AAoD. Causal analysis (Peter-Clark algorithm) suggested that age, BSA, hypertension, and alcohol consumption are possibly causally related to mid-AAoD, while diabetes and smoking are likely spuriously correlated. This study demonstrates the potential of DL and causal analysis for understanding ascending aortic morphology. By disentangling observed correlations using causal analysis, this approach identifies possible causal determinants, such as age, BSA, hypertension, and alcohol consumption. These findings can inform targeted diagnostics and preventive strategies, supporting clinical decision-making for cardiovascular health.

Age Related Histomorphological Changes in Aorta of Pig (Sus scrofa)

The present study was conducted during 2022 for a period of ten months ( January to October) in the Department of Veterinary Anatomy, in collaboration with ICAR-AICRP on pigs, C.V.Sc Tirupati, Andhra Pradesh, India on aorta of pigs (Sus scrofa). A total of 18 samples of thoracic and abdominal aorta were collected irrespective of sex of the animal. The samples were divided into three groups based on their age i.e., Group I (up to six months), Group II (seven months to one year) and Group III (above one year) and in each group six animals were studied for recording age-related histomorphological changes. In histomorphological study it was observed that the walls of both thoracic and abdominal aorta were made up of three layers viz., tunica intima, tunica media and tunica adventitia. The tunica intima was made up of endothelium, subendothelial tissue and internal elastic membrane. The thickness of tunica intima increased with advancement of age in both thoracic and abdominal aorta due to increase in the number of musculo-elastic layers. The thickness of tunica media increased with advancement of age of the pigs i.e., from group-I to group-II and decreased in group-III pigs in both thoracic and abdominal aorta. The thickness of tunica adventitia of thoracic aorta was less, when compared to tunica adventitia of abdominal aorta. The separate external elastic membrane was not identified in the aorta since it was merged with the adjacent elastic fibres. In the tunica adventitia numerous small blood vessels and few nerve fibres were observed.

Minimally invasive thoracic aortic surgery: our experience

The growing experience in minimally invasive techniques, supported by outstanding outcomes and excellent surgical exposure of the entire proximal thoracic aorta via ministernotomy, has motivated surgeons to apply this approach to more challenging procedures such as aortic root and arch treatment. From September 2016 to April 2024, 243 consecutive patients underwent proximal aortic surgical treatment through the ministernotomy approach at the Cardiac Surgery Unit of the Lancisi Cardiovascular Center of Ancona - Polytechnic University of Marche, Italy. In all cases, a preoperative computed tomography scan was performed. The mean age of the population was 65 ± 12 years, and 176 patients (72%) were male. Aortic valve disease occurred in 66.9% of cases (n=85) with significant aortic valve regurgitation or stenosis in 127 (52%) and 44 (18%) patients, respectively. Bicuspid aortic valve was found in 29% of patients (n=70). Surgical procedures included aortic root operations (n=88) using Bentall (n=64) or David (n=24) technique, isolated replacement of the ascending aorta (n=73), and combined treatment: replacement of the ascending aorta and the aortic valve (n=82). The 30-day mortality and stroke rate was 0.4%. In 132 patients (54%), extubation occurred within the first 6 h after surgical treatment. The median hospital stay was 7 days with 48% (n=107) of patients discharged home without need for any cardiac rehabilitation. Minimally invasive thoracic aortic surgery can be performed successfully at specialized cardiac surgery centers. Preoperative careful and accurate analysis of patient's computed tomography scan is essential to promote patient-tailored planning and promote optimal surgical exposure.

Role of Video Assisted Thoracoscopic Surgery (VATS) in the Management of Pulmonary Sequestration; A Meta-Analysis

Background: Pulmonary sequestration is a rare birth defect. It is a nonfunctioning dysplastic lung tissue without connection to the tracheobronchial tree, and its blood supply is from one or more aberrant systemic arteries. The aim of this study is to review the current literature regarding the role of video-assisted thoracic surgery (VATS) in the management of pulmonary sequestration. Objective: This review aims to assess the safety, efficacy, and outcomes of Video-Assisted Thoracoscopic Surgery (VATS) in managing pulmonary sequestration while considering patient characteristics, symptoms, arterial sources, surgical techniques, and postoperative advantages. Methods: The Web of Science, PubMed, MEDLINE, and Google Scholar were searched for articles published in English. Article titles containing the words “Video-Assisted Thoracoscopic Surgery for Pulmonary Sequestration and/or VATS” were filtered out of the search to exclude a large portion of irrelevant studies. The extracted data were analyzed. The data extracted were presented as frequencies and percentages. Results: After excluding the unrelated articles, 27 studies were identified for analysis; most of the studies (18) were case reports, with nine being case series, and the total number of patients who underwent pulmonary sequestration by VATS was 240. Both genders were equally affected (125, 52% were male and 115, 48% were female), the most common presenting symptom was coughing,and the descending thoracic aorta was the most common artery from which the feeders originated. About 149 patients (62.08%) underwent a lobectomy. Conclusion: Pulmonary sequestration can safely be treated by VATS at single or multiple ports with a shorter hospital stay, less postoperative pain, and fewer analgesic requirements.

Exploring Disparities in Atherosclerosis Comorbidity with Aortic Aneurysm

Aortic aneurysm (AA) and atherosclerosis (AS) of various vascular beds are asymptomatic for a long time and are relatively common pathological conditions that lead to life-threatening and disabling complications. In this review, we discuss the current understanding of the high variation in direct and inverse comorbidity of AA and AS as presented in scientific publications. Estimates of AA and AS comorbidity depend on several factors, such as the location of AA (ascending or descending thoracic aorta or abdominal aorta), familial or sporadic cases of AA, syndromic forms of AA, and/or aortic valve pathology (bicuspid aortic valve [BAV]). To identify the causes of the comorbidity of AA and AS, it is important to consider and characterise many factors in detail. These factors include clinical characteristics of the patients included in a study (age, sex) and risk factors (mainly the presence of monogenic forms and BAV, hypertension, hypercholesterolaemia, diabetes mellitus, and cigarette smoking). Additionally, it is essential to consider characteristics of the disease course and the nature of multimorbidity and to take into account pathologies not only of the cardiovascular system but also of other organ systems, with special attention to metabolic and endocrine disorders.

Thoracic aorta to inferior mesenteric artery bypass for treatment of chronic mesenteric ischemia

Thoracic aorta to inferior mesenteric artery bypass for treatment of chronic mesenteric ischemia

Impact of Open Surgical Descending Repair on Aortic Stiffness in an ExVivo Porcine Model.

Impact of Open Surgical Descending Repair on Aortic Stiffness in an ExVivo Porcine Model.

Sexual dimorphism in the downregulation of extracellular matrix genes contributes to aortic stiffness in female mice.

The contribution of sex hormones to cardiovascular disease, including arterial stiffness, is established; however, the role of sex chromosome interaction with sex hormones, particularly in women, is lagging. Arterial stiffness depends on the intrinsic properties and transmural wall geometry that comprise a network of cells and extracellular matrix (ECM) proteins expressed in a sex-dependent manner. In this study, we used four-core genotype (FCG) mice to determine the relative contribution of sex hormones versus sex chromosomes or their interaction with arterial stiffness. Gonadal intact FCG mice included females (F) and males (M) with either XX or XY sex chromosomes (n = 9-11/group). We isolated the thoracic aorta, and a tissue puller was used to assess structural resistance to changes in shape under control, collagenase, or elastase conditions. We determined histological collagen area fraction and evaluated aortic ECM genes by PCR microarrays followed by quantitative reverse transcription polymerase chain reaction (RT-qPCR). Stress-strain curves showed higher elastic modulus (P < 0.001), denoting decreased distensibility in XXF compared with XYF aortas, which were significantly reversed by collagenase and elastase treatments (P < 0.01). Aortic gene expression analysis indicated a significant reduction in Emilin1, Thbs2, and Icam1 in the XXF versus XYF aorta (P < 0.05). Uniaxial stretching of XXF aortic vascular smooth muscle cells indicated decreased Thbs2, Ctnna1, and Ecm1 genes. We observed a significant (P < 0.05) reduction in Masson's trichrome staining in collagenase but not elastase-treated aortic rings compared with the control. The increased aortic elastic modulus in XXF compared with XYF mice suggests a decrease in aortic distensibility mediated by a reduction in ECM genes.NEW & NOTEWORTHY FCG mice model can segregate vascular phenotypes by sex hormones, sex chromosomes, and their interaction. We show increased aortic stiffening in XX versus XY female mice and decreased ECM genes, suggesting decreased distensibility and impaired mechanotransduction in XXF versus XYF mice aortas. Therefore, the XX versus XY differences imply a unique role for sex chromosomes in regulating aortic integrity and ECM genes in female mice.

Engineering approach to study the effect of TEVAR on the cardiovascular system: A systematic review

Engineering approach to study the effect of TEVAR on the cardiovascular system: A systematic review

Takayasu Arteritis with medio-medial intussusception?

Takayasu Arteritis with medio-medial intussusception?

Quantitative Comparison of Different Parts of Tribulus terrestris L. at Different Harvest Times and Comparison of Antihypertensive Effects at the Same Harvest Time.

The whole plant of Tribulus terrestris (TT) is used to treat hypertension and cardio-cerebrovascular diseases. The harvest time has an important influence on the quality of medicinal plants. Therefore, it is necessary to study the effect of harvest time on the content of components in different parts of TT and compare the antihypertensive effect of different parts of TT at harvest time with a relatively high content of 14 components. Ultraviolet-visible spectrometry (UV-Vis spectrometry) was used to determine the total saponin content in T. terrestris fruit (TTF), T. terrestris stems (TTS), and T. terrestris leaves (TTL) at different harvest times. Within the studied harvest times, the total saponin content was higher in TTL than in TTF or TTS. Ultra-high performance liquid chromatography-triple quadrupole tandem mass spectrometry analysis revealed significant differences in the spatial and temporal differences in the content of 14 components in the three plant parts. The multivariate statistical analysis identified six components as markers of different TT content in the different parts. The suitable TTF harvest period was from August 11 to September 1, while TTS and TTL were suitable for harvesting from July 21 to September 11. The treatment effects on blood pressure, serum indexes, and thoracic aorta morphology confirmed that the antihypertensive effects of TTL were better than those of TTF or TTS. The study emphasized the effect of harvest time on the content of components in different parts of TT and confirmed that TTS and TTL also had medicinal value.

Association of thoracic aortic calcium with incident cardiovascular disease and all-cause mortality across the spectrum of coronary artery calcium burden.

Association of thoracic aortic calcium with incident cardiovascular disease and all-cause mortality across the spectrum of coronary artery calcium burden.

Administration of the KCa channel activator SKA-31 improves endothelial function in the aorta of atherosclerosis-prone mice

IntroductionAtherosclerosis remains a major risk factor for vascular dysfunction and cardiovascular (CV) disease. Pharmacological enhancement of endothelial Ca2+-activated K+ channel activity (i.e., KCa2.3 and KCa3.1) opposes vascular dysfunction associated with ageing and type 2 diabetes (T2D) in ex vivo and in vivo preparations. In the current study, we have investigated the efficacy of this strategy to mitigate endothelial dysfunction in the setting of atherogenesis.MethodsMale apolipoprotein E knockout (Apoe−/−) mice fed a high fat diet (HFD) were treated daily with the KCa channel activator SKA-31 (10 mg/kg), the KCa3.1 channel blocker senicapoc (40 mg/kg), or drug vehicle for 12-weeks. Endothelium-dependent and -independent relaxation and vasocontractility were measured in abdominal aorta by wire myography. The development of atherosclerosis in the thoracic aorta was characterized by Oil Red O staining and immunohistochemistry. Key vasorelaxant signaling proteins were quantified by q-PCR.ResultsEndothelium-dependent relaxation of phenylephrine-constricted aortic rings was impaired in Apoe−/− HFD mice (53%) vs. wild-type (WT) controls (80%, P &amp;lt; 0.0001), consistent with endothelial dysfunction. Treatment of Apoe−/− HFD mice with SKA-31, but not senicapoc, restored maximal relaxation to the WT level. Phenylephrine-evoked contraction was similar in WT and vehicle/drug treated Apoe−/− mice, as was the maximal relaxation induced by the endothelium-independent vasodilator sodium nitroprusside. mRNA expression for eNOS, KCa3.1, KCa2.3 and TRPV4 channels in the abdominal aorta was unaffected by either SKA-31 or senicapoc treatment. Fatty plaque formation, tissue collagen, α-smooth muscle actin and resident macrophages in the aortic sinus were also unaltered by either treatment vs. vehicle treated Apoe−/− HFD mice.ConclusionOur data show that prolonged administration of the KCa channel activator SKA-31 improved endothelial function without modifying fatty plaque formation in the aorta of Apoe−/− mice.

The role of LNK in mitigating hypertension: inhibition of vascular smooth muscle proliferation and JAK-STAT pathway.

The lymphocyte adaptor protein LNK is predominantly found in endothelial and hematopoietic cells and is linked to cardiovascular and autoimmune diseases. LNK functions as a negative regulator of cytokine signaling and cell proliferation, but its impact on hypertensive vascular smooth muscle cells (HVSMC) remains unclear. This study aimed to explore the influence of LNK on HVSMC function. To achieve this, vascular smooth muscle cells (VSMCs) from rat thoracic aorta were isolated and identified using immunofluorescence. A hypertensive cell model was established by treatment with angiotensin-II, confirmed through the MTT method. Lentivirus was utilized to create stable silencing and overexpression of the LNK gene. Flow cytometry assessed VSMC cycle, proliferation, and migration levels, while ELISA measured IL-6, TNF-α, and IFN-γ expression levels. Real-time quantitative PCR and western blot were employed to analyze LNK, STAT3, JAK1, JAK2, JAK3 mRNA, and protein expression in rat VSMC. Immunofluorescence results indicated that most VSMCs expressed vimentin, with a proliferation rate of 48.5% in VSMCs treated with 100nM angiotensin-II, confirming successful isolation and model construction of HVSMC. Compared to the control group, the angiotensin-II group exhibited increased HVSMCs in S and G2/M-phases of the cell cycle, decreased in G0/G1 phases, higher proliferation and migration capacity, and elevated inflammation levels. Additionally, JAK1, JAK2, and STAT3 signaling pathway-related mRNA and protein expression were significantly elevated. These effects were further intensified by the combined action of angiotensin-II and LNK silencing virus. Conversely, these effects were notably reduced when angiotensin-II was combined with the LNK overexpressing virus. These findings suggest that LNK mitigates the impact of hypertension and inflammation by inhibiting the proliferation, migration, and JAK-STAT signaling pathway of HVSMCs.

Stabilisation of extracellular matrix is crucial to rapamycin-mediated life span increase in Marfan mgR/mgR mice.

Stabilisation of extracellular matrix is crucial to rapamycin-mediated life span increase in Marfan mgR/mgR mice.

Growth Rate Assessed by Vascular Deformation Mapping Predicts Type B Aortic Dissection in Marfan Syndrome.

Patients with Marfan syndrome (MFS) are at a high risk of type B aortic dissection (TBAD). Aortic growth and elongation have been suggested as risk factors for TBAD. Vascular deformation mapping is an image analysis technique for mapping 3-dimensional aortic growth on routine computed tomography angiography (CTA) scans. We aimed to use vascular deformation mapping to examine the value of aortic growth rate in the descending thoracic aorta, among other imaging biomarkers, to identify the factors associated with risk of TBAD in MFS. Computed tomography angiography scans spanning 2004 to 2023 from adult patients with MFS with native descending thoracic aorta were analyzed by vascular deformation mapping. Other measurements included multilevel thoracoabdominal aortic diameters and the length of the descending thoracic aorta by centerline analysis. Among the 105 patients with MFS analyzed, 63.8% were men, with median age of 40 (range, 18-73) years and a median surveillance interval of 5.3 (range, 2.0-18.3) years. During surveillance, 12 (11.4%) patients developed TBAD. Patients with TBAD had a higher radial growth rate (0.63 versus 0.23 mm/year; P<0.001) and elongation rate (2.4 versus 0.5 mm/year; P<0.001), on univariate and multivariable analysis, but predissection descending aortic diameter was not significantly different. Predictors of growth rate included younger age, higher baseline maximal diameter of the descending thoracic aorta, smoking history, and warfarin use. Radial growth and elongation rates of the descending thoracic aorta were independent predictors of TBAD occurrence in MFS. TBAD often occurred at nonaneurysmal diameters (<4.0 cm). These findings emphasize the role of growth over absolute diameter in risk stratification for TBAD in MFS.