Background: The aim of this study was to evaluate the aortic diameter and volume during the first year after a type A repair to predict the long-term prognosis of a residual aortic dissection (RAD). Methods: All patients treated in our center for an acute type A dissection with a RAD and follow-up > 3 years were included. We defined two groups: group 1 with dissection-related events (defined as an aneurysmal evolution, distal reintervention, or aortic-related death) and group 2 without dissection-related events. The aortic diameters and volume analysis were evaluated on three postoperative CT scans: pre-discharge (T1), 3–6 months (T2) and 1 year (T3). Results: Between 2009 and 2016, 54 patients were included. Following a mean follow-up of 75.4 months (SD 31.5), the rate of dissection-related events was 62.9% (34/54). The total aortic diameters of the descending thoracic aorta were greater in group 1 at T1, T2 and T3, with greater diameters in the FL (p < 0.01). The aortic diameter evolution at 3 months was not predictive of long-term dissection-related events. The total thoracic aortic volume was significantly greater in group 1 at T1 (p < 0.01), T2 (p < 0.01), and T3 (p < 0.01). At 3 months, the increase in the FL volume was significantly greater in group 1 (p < 0.01) and was predictive for long-term dissection-related events. Conclusion: This study shows that an initial CT scan volume analysis coupled with another at 3 months is predictive for the long-term evolution in a RAD. Based on this finding, more aggressive treatment could be given at an earlier stage.

Background: Long-term follow-up after endovascular aortic repair (TEVAR) is crucial to detect adverse aortic remodeling, even with modern stent grafts offering enhanced flexibility and durability. Conventional imaging, based on diameter measurements, may fail to identify complications such as endograft migration. Methods: We conducted a longitudinal 3D geometric analysis of thoracic aortic and stent-graft evolution over 10 years in a patient treated for descending thoracic aortic aneurysm (DTAA) by endovascular treatment. A three-dimensional morphological analysis (length, tortuosity, angulation, and diameter) was carried out using advanced imaging software (EndoSize, MATLAB) to track aortic geometry and stent-graft behavior over time. A focused review of the literature on stent-graft migration, its risk factors, complications, and surveillance strategies was also performed. Results: This case illustrates how progressive geometric remodeling—including aortic elongation and increased tortuosity—can lead to delayed stent-graft migration and late type III endoleaks, with an elevated risk of rupture. The 3D analysis revealed early morphological changes that were undetectable using standard diameter-based follow-up. These observations are consistent with published data showing higher migration rates over time, particularly in tortuous anatomies. The literature review further emphasizes the clinical relevance of geometric surveillance, given the high rates of reintervention, morbidity, and mortality associated with stent-graft migration. Conclusions: This study underlines the importance of personalized and geometry-based surveillance after TEVAR. Advanced morphological assessment tools provide valuable insights for the early detection of complications and tailored patient management. Their integration into routine follow-up could help optimize long-term outcomes and prevent life-threatening events such as rupture.

Residual thoracic aortic dissection (RTAD) is a pathology whose patient‐dependent evolution is an important clinical issue, and for which numerical fluid–structure interaction (FSI) models can be helpful. However, the proposal of an ad hoc mechanical wall and flap model remains a challenge. To make progress on this issue, we seek to understand the respective influence of the flap and the wall in interaction with the flow in RTAD. Based on a patient's RTAD geometry, we established different FSI models to simulate the mechanical behaviour of the wall and flap. We varied the Young's modulus of the wall between 1.2 MPa (W12) and 2.7 MPa (W27) and the Young's modulus of the flap between 0.6 MPa (F06) and 1.2 MPa (F12), resulting in 3 different cases to study (F06W12, F12W12 and F06W27) and allowing a relative comparison. Structural displacements and stresses are equivalent in F06W12 and F12W12, resulting in equivalent flow characteristics. When comparing F06W12 with F06W27, we show that a stiffer wall reduces flap motion by 49.8%, 51% and 52% respectively, around the first entry tear, second and third one respectively. The difference in flow pressure between channels, which reflects the resistance to flow, is very small (about 1–2 mmHg) and similar for all 3 cases. This result seems to be highly related to the current geometry with one entry and two re‐entry tears. Our results show that the wall is the main driver of the overall mechanical behaviour of the RTAD. We demonstrated that a stiffer pathological wall leads to smaller flap displacements, which is consistent with clinical observations in the chronic phase.

Objectives: To assess the ability of the aortic aneurysm volume (AAV), aneurysmal lumen volume (ALV), and aneurysmal thrombus volume (ATV) to predict the need for aortic reintervention when using the maximal aortic diameter as a reference. Methods: This monocentric retrospective study included 31 consecutive patients who underwent successful thoracic endovascular aortic repair (TEVAR) to treat an atheromatous thoracic aortic aneurysm. All patients underwent clinical and computed tomography angiography (CTA) for 3 years after TEVAR. The patients were categorized into group 0 if no aortic reintervention was required during the follow-up period and categorized into group 1 if they experienced a type I or III endoleak or aneurysm diameter increase requiring intervention. The maximum aneurysm sac diameter and the AAV, ALV, and ATV were calculated using CTA images obtained preoperatively (T0) and at 6–12 months (T1), 24 months (T2), and 36 months (T3) postoperatively, and their changes over time were analyzed. Correlations between diameter and changes in AAV, ALV, and ATV were assessed, and the association between diameter and volume changes and reintervetion was examined. The cutoff values for predicting the need for reintervention was determined using a receiver operating characteristic (ROC) curve. The accuracy of volume change versus diameter change for predicting the need for reintervention was analyzed. Results: There were no significant differences in terms of the mean aneurysm diameter or AAV, ALV or ATV between the groups at preoperative CTA or after one year of follow-up imaging. The mean ATV was higher in group 1 than in group 0 at 2 years (187.6 ± 86.3 mL vs. 114.7 ± 64.7 mL; p = 0.057) and after 3 years (195.0 ± 86.7 mL vs. 82.1 ± 39.9 mL; p = 0.013). The maximal diameter was greater in group 1 than in group 0 at 3 years (67.3 ± 9.5 mm vs. 55.3 ± 12.6 mm; p = 0.044). The rate of AAV change between T0 and T1 was significantly higher in group 1 (7 ± 4.5%) than in group 0 (−6 ± 6.8%; p < 0.001). The rate of ATV change between T1-T3 was significantly higher in group 1 than in group 0 (34 ± 40.9% vs. −13 ± 14.4% (p = 0.041)); similar results were observed for the rate of ATV change between T2 and T3 (27 ± 50.1% for group 1 vs. −8 ± 49.5% in group 0 (p < 0.001)). According to our multivariate analysis, the annual growth rate for AAV between T0 and T1 was the only independent factor that was significantly associated with aortic reintervention (area under the curve (AUC) = 0.84, OR = 1.57, p = 0.025; optimal cutoff +0.4%). An increase in the annual growth rate of the ATV between T0 and T3 was independently associated with the need for aortic reintervention (area under the curve (AUC) = 0.90, OR = 1.11, p = 0.0347; optimal cutoff +10.1%). Conclusions: Aortic volume analysis can predict the need for aortic reintervention more accurately and earlier than maximal aortic diameter.