1. LAUREN SINNENBERG BS, WILSON SZETO, MD, PATRICK MOELLER BS, PRASHANTH VALLABHAJOSYULA, MD, G. WILLIAM MOSER, CRNP, NIMESH DESAI, MD PHD, JOSEPH BAVARIA, MD. Aortic Remodeling after Endovascular Repair of the Descending Thoracic Aorta HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA DIVISION OF CARDIOVASCULAR SURGERY

2. Background Since thoracic endovascular aortic repair (TEVAR) is a relatively new technique, there is a lack of long term follow-up on patients who have undergone TEVAR. This project aims to elucidate aortic remodeling that occurs during this long term follow- up period.

3. Methods Retrospective review of all evaluable CT angiograms submitted to M2S in patients with TEVAR who have at least 300 days of follow up Of 730 TEVAR patients, 86 have been evaluated Aortic length measurement: measured in mm from centerline slices from celiac artery to left subclavian artery (or next proximal vessel if the left subclavian artery was covered by the stent) using the M2S software

4. Change in aortic length Mean ± SD Total change in aorta length (mm)11.4 ± 25.6 Annualized change in aorta length (mm/year)5.4 ± 11.1 Time between first and last scan (days)868.7 ± 669.6 Annualized change# of PatientsPercent of patients >10 mm/year change1922.1% 5-10 mm/year change1416.3% -5-5 mm/year change4350.0% <-10 mm/year change1011.6%

5. Change in aortic length by age at last scan # of Patients% PatientsMean change in aortic length (mm) Annualized mean change in aortic length (mm/year) <65 years old1315.1%3.2 ± 13.83.4 ± 13.1 65-75 years old 2124.4%4.5 ± 17.13.4 ± 10.6 >75 years old5260.5%16.3 ± 29.56.7 ± 10.7

6. Change in aortic length by surgical indication # of Patients% PatientsMean change in aortic length (mm) Annualized mean change in aortic length (mm/year) Aneurysm6980.2%11.1 ± 22.16.3 ± 11.2 Dissection1112.8%3.8 ± 17.40 ± 5.7 Redo TEVAR55.8%36.8 ± 61.28.8 ± 14.0 * 1 patient had TEVAR due to transection and was left within its own category

7. Change in aortic length by number of stents implanted # of Patients% PatientsMean change in aortic length (mm) Annualized mean change in aortic length (mm/year) 1 stent2731.4%5.2 ± 20.22.8 ± 10.2 2 stents2731.4%9.6 ± 23.16.1 ± 10.5 3 stents1112.8%2.6 ± 24.34.7 ± 15.4 >4 stents2124.4%23 ± 32.58.2 ± 10.2

8. Conclusions Aortic lengthening occurred in up to 38% of all patients who underwent TEVAR Lengthening of greater than 1 cm occurred in 22% of patients Lengthening may be dependent on patient age, surgical indication and number of stents implanted