Predictive Value of the Preoperative Descending Aortic Tortuosity Index for Endoleak After Thoracic Endovascular Aortic Repair in Acute Type B Aortic Dissection
Background:Endoleak is one of the most common adverse events after thoracic endovascular aortic repair (TEVAR) in patients with acute complicated Stanford type B aortic dissection (cTBAD). Interestingly, endoleak may affect aortic remodeling and increase the risk of reintervention. Previous studies on postoperative endoleak have mainly focused on local anatomical parameters of the landing zone. In contrast, the predictive value of overall descending aortic morphology, particularly the descending aortic tortuosity index (DATI), has not been systematically evaluated. Therefore, this study aimed to assess the predictive value of preoperative DATI for postoperative endoleaks after TEVAR in patients with acute cTBAD.Methods:This single-center retrospective observational study included 221 patients with acute cTBAD who underwent TEVAR at our hospital between January 2021 and December 2025. DATI and other aortic morphological parameters were measured using centerline reconstruction based on preoperative aortic computed tomography angiography (CTA). Patients were divided into an endoleak group and a non-endoleak group according to the occurrence of persistent or new-onset postoperative endoleak during follow-up. Baseline characteristics, imaging parameters, perioperative data, endoleak types, false lumen perfusion, and false lumen thrombosis status were compared between the two groups. Univariable and multivariable logistic regression analyses were used to evaluate factors associated with postoperative endoleak. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminatory performance of DATI, and Kaplan–Meier curves and Cox proportional hazards regression were used to evaluate the association between DATI and time to endoleak onset.Results:The median duration of postoperative imaging follow-up was 12 (6–18) months. During follow-up, 38 of 221 patients (17.2%) experienced persistent or new-onset postoperative endoleak. Among these patients, 22 had type IA endoleak (10.0% of the overall cohort and 57.9% of endoleak events), eight had type IB endoleak (3.6% and 21.1%), five had type II endoleak (2.3% and 13.2%), and three had type III endoleak (1.4% and 7.9%). A total of 28 endoleaks (73.7%) were detected on the first postoperative CTA, and 10 (26.3%) were first identified on subsequent follow-up CTA. DATI was significantly higher in the endoleak group than in the non-endoleak group (26.1 ± 8.5% vs 18.3 ± 7.2%; p < 0.001). Multivariable logistic regression showed that DATI (odds ratio (OR) = 1.09; 95% confidence interval (CI), 1.04–1.14; p < 0.001), proximal landing zone length (OR = 0.91; 95% CI, 0.85–0.98; p = 0.008), and immediate intraoperative endoleak (OR = 2.85; 95% CI, 1.08–7.52; p = 0.034) were independently associated with postoperative endoleak. ROC curve analysis showed that the area under the receiver operating characteristic (AUROC) curve of DATI for predicting postoperative endoleak was 0.783 (95% CI, 0.710–0.856). The optimal cutoff value was 22.5%, with a sensitivity of 71.1% and a specificity of 74.3%. Kaplan–Meier analysis showed that patients with DATI ≥22.5% had lower endoleak-free survival than those with DATI <22.5% (log-rank p < 0.001). In the adjusted Cox model, DATI ≥22.5% remained associated with the occurrence of endoleak (adjusted hazard ratio (HR) = 4.38; 95% CI, 2.08–9.21; p < 0.001).Conclusion:In this single-center retrospective study, preoperative DATI may be independently associated with persistent or new-onset endoleak after TEVAR in patients with acute cTBAD and may have moderate discriminatory ability. A DATI ≥22.5% may indicate a higher risk of endoleak during follow-up. Incorporating DATI into preoperative morphological assessment may serve as an adjunct to risk stratification and procedural planning, although this cutoff value requires external validation.