ORIGINAL SCIENTIFIC REPORT Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection Viony M. Belvroy 1,2,3 • Hector W. L. de Beaufort 1,2 • Joost A. van Herwaarden 2 • Jean Bismuth 3 • Gabriele Piffaretti 4 • Frans L. Moll 2 • Santi Trimarchi 5,6 Ó Socie ´te ´ Internationale de Chirurgie 2019 Abstract Objective Tortuosity in the descending thoracic aorta (DTA) comes with aging and increases the risk of endoleaks after TEVAR. With this report, we would like to define and classify tortuosity in the DTA of patients with thoracic aortic disease. Methods Retrospective case–control study of two hundred seven patients, comparing sixty-nine controls without aortic disease (CG), to sixty-nine patients with descending thoracic aortic aneurysm (AG) and sixty-nine patients with type B aortic dissection (DG). 3Mensio Vascular software was used to analyze CTA scans and collect the following measurements; tortuosity index, curvature ratio and the maximum tortuosity of the DTA. The DTA was divided into four equal zones. The maximum tortuosity was divided into three groups: low ( \ 30°), moderate (30°– 60°) and high tortuosity ( [ 60°). Results Compared to the CG, tortuosity was more pronounced in the DG, and even more in the AG, evidenced by the tortuosity index (1.11 vs. 1.20 vs. 1.31; p \ 0.001), curvature ratio (1.00 vs. 1.01 vs. 1.03; p \ 0.001), maximum tortuosity in degrees (28.17 vs. 33.29 vs. 43.83; p \ 0.001) and group of tortuosity (p \ 0.001). The maximum tortuosity was further distal for the DG and AG, evidenced by the zone of maximum tortuosity (4A vs. 4B vs. 4B; p \ 0.001). Conclusion This study shows that tortuosity in the DTA is more prominent in diseased aortas, especially in aneurysmal disease. This phenomenon needs to be taken into account during planning of TEVAR to prevent stent graft-related complications and to obtain positive long-term outcome. Awarded with 2nd prize for best poster presentation at the ESVS 32nd Annual Meeting 2018, September 25–28, Valencia, Spain & Viony M. Belvroy vionybelvroy@hotmail.com 1 Thoracic Aortic Research Center, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Italy 2 Department of Vascular Surgery, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands 3 Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St, Houston, TX 77030, USA 4 Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Viale Luigi Borri 57, 21100 Varese, Italy 5 Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan, Via Della Commenda 10, 20122 Milan, Italy 6 Department of Clinical and Community Science, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy 123 World J Surg https://doi.org/10.1007/s00268-019-05328-w