Quantitative Assessment of Aortic Arch Conformability and Clinical Outcomes Following Thoracic Endovascular Aortic Repair

PURPOSE: Thoracic stent graft conformability is believed to provide mechanical advantages during thoracic endovascular aortic repair (TEVAR); however, quantitative evidence and associated clinical outcomes remain limited. This study aimed to assess stent graft conformability across varying aortic arch configurations and pathologies, and to evaluate short- and mid-term technical and clinical outcomes. MATERIALS AND METHODS: A retrospective, single-centre review was conducted of TEVAR procedures performed using the GORE cTAG stent graft over a seven-year period. Pre- and post-deployment anatomical measurements were obtained using Endosize® software to assess conformability across a range of aortic arch morphologies and aortic syndromes. Conformability was defined as a < 10% change in predefined anatomical parameters, including aortic arch angle and proximal landing zone (PLZ) angle. Demographic data, mortality, complications, incidence of bird beaking, and reintervention rates were analysed. RESULTS: Of 189 TEVAR procedures performed during the study period, 111 met inclusion criteria and utilised the GORE cTAG stent graft. High conformability was observed following intervention, with 79% of patients demonstrating < 10% change in aortic arch angle and 88% demonstrating < 10% change in PLZ angle. Bird beaking occurred in 10.8% of patients. The overall reintervention rate was 5.4%, with greater angular changes significantly associated with reintervention (p = 0.039). Overall survival rates at 30 days, 1 year, and 5 years were 95%, 86%, and 80%, respectively. CONCLUSION: The GORE cTAG stent graft demonstrates high conformability across diverse aortic arch morphologies and pathologies, which is associated with favourable short- and mid-term technical and clinical outcomes.