Advancing Thoracic Aortic Aneurysm Management: A Multimodal Approach Integrating Clinical Practice, Biomechanical Characteristics and Imaging-Based Dynamic Metrics

Abstract

This thesis aims to adopt a multidisciplinary approach to address the complexities currently associated with TAA, particularly in informing disease progression, risk stratification, and understanding its natural history. The collective knowledge from clinical practice, biomechanical characteristics, and imaging-based dynamic metrics is leveraged to uncover new insights into thoracic aortic aneurysm (TAA) and to improve assessment of disease severity, progression and risk stratification. Chapter 2 explored the incidence and prevalence of thoracic aortic aneurysm among the Medicare population, along with the subsequent outcomes and their use of surgical interventions. In Chapter 3, we investigated the potential of VDM as a tool to quantify three-dimensional aortic motion and stiffness among patients with various types of aortic disease. In Chapter 4 we utilized VDM to characterize three-dimensional aortic motion and distensibility in relation to growth, in patients with sporadic thoracic aortic aneurysm, Marfan as well as non-dilated aortas. In Chapter 5, we utilized VDM to investigate the impact of thoracic endovascular aortic repair (TEVAR) on aortic motion and distensibility. In Chapter 6, we used VDM to investigate the degree of pre-surgical arch growth and to examine how well proximal arch diameter indicates arch involvement by the primary ascending aneurysm. In Chapter 7, we utilized VDM to assess if the baseline diameter in a pre-surgical aTAA population predicted future growth.