Objective: To investigate the relationship between the aortic arch Tortuosity Index (TI) and post-TEVAR aortic enlargement in patients with type B aortic dissection (TBAD) requiring left subclavian artery (LSA) reconstruction with a single-branched stent-graft. Methods: We retrospectively analyzed 120 patients enrolled in a prospective multicenter clinical trial between December 2020 and November 2021. The aortic arch TI was measured to quantify arch tortuosity. The study evaluated the independent association between TI and the risk of post-TEVAR aortic enlargement using multivariable Cox regression analysis. Furthermore, we estimated enlargement-free survival in patients stratified by TI levels and verified the diagnostic performance of TI for both thoracic and abdominal aortic enlargement. Results: The mean age was 57.0 ± 10.6 years. Multivariable Cox regression revealed TI was independently associated with both thoracic (HR, 3.8; 95% CI, 2.2–6.6; p < 0.001) and abdominal aortic enlargement (HR, 2.5; 95% CI, 1.6–4.1; p < 0.001). Kaplan–Meier survival curves demonstrated that freedom from aortic enlargement was significantly lower in the High-TI group (p < 0.001). ROC curves confirmed excellent discriminative ability for thoracic (AUC: 0.857, 95% CI, 0.775–0.940) and abdominal (AUC: 0.833, 95% CI, 0.756–0.910) enlargement. Conclusions: In TBAD patients requiring LSA reconstruction with a single-branched stent-graft, the aortic arch tortuosity is independently associated with post-TEVAR aortic enlargement. Preoperative measurement of the aortic arch tortuosity contributes to risk stratification in patients with TBAD and may identify those requiring intensified postoperative surveillance.
Zhu et al. (Wed,) studied this question.