Morphologic and Longitudinal Assessment in Thoracic Aortic Disease Management

This thesis provides a contribution to the knowledge on diagnostics and therapeutics in thoracic aortic pathology. Conventional versus hybrid therapy in type A aortic dissection (TAAD) is discussed. The thesis concludes that area measurements are more reliable than diameter measurements in TAAD analysis. Furthermore, the current status of thoracic endovascular aortic repair (TEVAR) in TAAD is evaluated. In the next part of the thesis, focus is placed on the descending thoracic aorta, where long-term TEVAR results are analyzed and where distinction between dissections and intramural hematoma in the literature is evaluated. Moreover, a critical analysis patients with compromised distal landing zones receiving TEVAR is presented, discussing the need for initial prevention of type Ib endoleaks. Additionally, the thesis presents a multiparametric analysis, combining 3 dimensional interval computed tomography angiography analysis and computational analysis of transmural cyclic stress finding colocalization of maximal stress and growth points and type B aortic dissections. Ultimately, an analysis is presented on morphologic left ventricle changes in a group of 47 patients with an aneurysmatic ascending aorta, receiving conventional repair, compared to a group of 51 conservatively treated patients. An myocardial increase of 7% versus 1% respectively, strengthens the hypothesis that rigid synthetic grafts increase stiffness in the aortic system, leading to a higher central aortic pressure, which potentially has an adverse left ventricle remodelling effect.