Tortuosity of the descending thoracic aorta: Normal values by age

• Published in: PloS one Vol. 14; no. 4; p. e0215549
• Main Authors: Belvroy, Viony M., de Beaufort, Hector W.L., van Herwaarden, Joost A., Bismuth, Jean, Moll, Frans L., Trimarchi, Santi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23.04.2019; Public Library of Science (PLoS)
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Aging (Biology); Aging - physiology; Analysis; Aorta, Thoracic - anatomy & histology; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - physiology; Aortic Diseases - surgery; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - methods; Cardiovascular diseases; CAT scans; Diagnostic imaging; Endovascular Procedures - instrumentation; Endovascular Procedures - methods; Female; Health aspects; Healthy Volunteers; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Reference Values; Regression analysis; Retrospective Studies; Sex Factors; Stents; Thoracic aorta; Tomography, X-Ray Computed; Vascular diseases; Vascular surgery
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0215549

Aging changes the aorta in length, tortuosity and diameter. This is relevant in thoracic endovascular aortic repair (TEVAR) and in the long term follow up. Two groups of hundred patients < 65 years and hundred patients ≥ 65 years, with no vascular diseases were made. Thin cut CT scans were analyzed with 3Mensio Vascular software and the following measurements were collected; tortuosity index, curvature ratio, maximum tortuosity in degrees and the level of vertebrae of the maximum tortuosity. The descending thoracic aorta (DTA) was analyzed and was divided into four zones of equal length. Subjects were divided into three groups based on their maximum tortuosity value: low (< 30°), moderate (30° - 60°) and high (> 60°). A linear regression model was built to test the effect of age and gender on tortuosity. Tortuosity was more pronounced in the ≥ 65 compared to the < 65 group (tortuosity index: 1.05 vs. 1.14, respectively; p < 0.001), curvature ratio (1.00 vs. 1.01; p < 0.001), maximum tortuosity (22.24 vs. 27.26; p < 0.001), and group of angulation (low vs. low; p < 0.001). Additionally, the location of maximum tortuosity was further distal for the ≥ 65 group (level of vertebrae; 5.00 vs. 5.00; p < 0.001), and zone of maximum tortuosity (4A vs. 4A; p < 0.001). There was no significant difference between male and female subjects. Normal DTA tortuosity increases with age. This is important to understand natural aging and for TEVAR planning and follow-up.