Volumetric Analysis of Aortic Changes after TEVAR Using Three-Dimensional Virtual Modeling

Abstract

TEVAR (thoracic endovascular aortic repair) is the preferred approach for treating descending thoracic aortic aneurysm (DTAA). After the procedure, patients require lifelong CTA (computed tomography angiography) follow-up to monitor the aorta’s remodeling process and the possible development of associated complications. With CTA, the aorta is usually measured with maximum diameters taken at specific locations, and even in experienced centers, this type of evaluation is prone to inter-observer variability. We introduce a new volumetric analysis of aortic changes after TEVAR using three-dimensional (3D) anatomical models. We applied the volumetric analysis to 24 patients who underwent TEVAR for DTAA. For each patient, the descending thoracic aorta was evaluated using both the maximum diameter from CTA and the volume from 3D reconstructions, at discharge and 12 months after TEVAR. Both volume and diameter evaluations were then related to the development of TEVAR complications. The group with TEVAR-related complications showed a 10% volume increase in the descending aorta, while the group with no TEVAR-related complications only had a 1% increase. An increase of 40 mL in the descending aorta volume at 12 months seemed to be predictive of complications, with 94% specificity and 75% sensitivity. Volumetric analysis is a promising method for monitoring DTAA remodeling after TEVAR, and it may help in the early identification of high-risk patients who may benefit from a stricter follow-up, even if further evaluations on a larger sample size are required to confirm these preliminary results.

Keywords

• 3D virtual modeling
• TEVAR
• aortic volume
• thoracic aortic aneurysm
• aortic remodeling