title: Impact on outcomes by measuring tortuosity with reporting standards for thoracic endovascular aortic repair.
abstract: OBJECTIVE
  In this study, we assessed the association between the tortuosity of the thoracic aorta as measured by the reporting standards for thoracic endovascular aortic repair (TEVAR), described by the Society for Vascular Surgery, and midterm outcomes after TEVAR for atherosclerotic aneurysms.
  
  
  METHODS
  We analyzed 77 consecutive patients who underwent TEVAR for atherosclerotic aneurysms from November 2006 through May 2013 in a single institution. The preoperative aortic tortuosity index (TI) was calculated by computed tomography aortography, and patients were divided into low-tortuosity (TI ≤ 1.29) and high-tortuosity (TI > 1.29) groups. The relationships between TI and the occurrence of endoleaks, complications, and survival were analyzed.
  
  
  RESULTS
  The mean follow-up period was 29 ± 26 months. During this period, endoleaks occurred in 19 patients. Patients in the high-tortuosity group were at greater risk for endoleaks (odds ratio, 9.95; 95% confidence interval, 2.06-48.1; P = .004) and stroke (odds ratio, 13.2; 95% confidence interval, 1.03-169; P = .047) than those in the low-tortuosity group. The overall survival at 1, 3, and 5 years was 73%, 69%, and 63%, respectively, for the high-tortuosity group and 92%, 92%, and 86%, respectively, for the low tortuosity group.
  
  
  CONCLUSIONS
  Our findings demonstrated that high tortuosity of the thoracic aorta is associated with higher rates of endoleaks and lower survival in patients undergoing TEVAR for atherosclerotic aneurysms. Patients with aneurysms in a highly tortuous aorta may therefore need greater attention in preoperative planning, perioperative procedures, and follow-up examinations.
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chun-Ku
authors.initials: CK
authors.lastname: Chen
authors.affiliation: Department of Radiology, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.
authors.forename: I-Ping
authors.initials: IP
authors.lastname: Liang
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Family Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
authors.forename: Hsiao-Ting
authors.initials: HT
authors.lastname: Chang
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Surgery, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
authors.forename: Wei-Yuan
authors.initials: WY
authors.lastname: Chen
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Institutes of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: I-Ming
authors.initials: IM
authors.lastname: Chen
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Mei-Han
authors.initials: MH
authors.lastname: Wu
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Sheu
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Institutes of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: ccshih@vghtpe.gov.tw.
authors.forename: Chun-Che
authors.initials: CC
authors.lastname: Shih
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D001807:Blood Vessel Prosthesis; D057867:Endoleak / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011474:Prosthesis Design; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014102:Torsion Abnormality / Q000150:complications* / Q000000981:diagnostic imaging