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J Thorac Dis. 2018 Apr;10(4):2100-2107. doi: 10.21037/jtd.2018.03.72.

A simple patient-tailored aortic arch tangential angle measuring method to achieve better clinical results for thoracic endovascular repair of type B aortic dissection.

Wang L1,2,3, Hou K4,5, Xu X1,2, Chen B1,2, Jiang J1,2, Shi Z1,2, Tang X1,2, Guo D1,2, Fu W1,2,3.

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Department of Vascular Surgery, Fudan University, Shanghai 200032, China.
Institute of Vascular Surgery, Fudan University, Shanghai 200032, China.
Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen 361015, China.
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Institute of Radiology, Shanghai Municipal, Shanghai 200032, China.



To report a simple individual tailored aortic arch tangential angle (θ-AATA) measuring method and its clinical application efficacy in the endovascular treatment of type B aortic dissection (AD).


From January 2013 to December 2014, acute type B AD patients were prospectively enrolled and treated with endovascular therapy in our center. Among these patients, a specific method was applied to measure θ-AATA based on the axial images of the CT scan. The length of proximal landing zone (PLZ) of each patient was measured at the routinely applied left-anterior oblique (LAO) 45-degree and θ-AATA. Respective treatment strategies based on the length of the PLZ were planned accordingly, and the stent-graft was deployed under the fluoroscopy at θ-AATA. The occurrence of immediate type I endoleak was recorded during the completion angiogram, while the alignment of the proximal marks was determined under fluoroscopy at θ-AATA and at LAO-45-degree as well.


Totally 76 patients with type B AD were prospectively enrolled. The average value of θ-AATA was 58.3±5.2 degrees, which was significantly larger than the routine 45 degrees (P<0.01). The mean landing zone length measured under θ-AATA (18.4±3.9 mm) was longer than that (15.9±3.1 mm) obtained at the routine LAO-45 degrees (P<0.05). Stent-grafts' deployment strategies were substantially changed accordingly. Alignment of the proximal marks was achieved in 72 patients (93.4%) under θ-AATA and only in two patients (2.7%) at LAO-45 degrees (P<0.01). All stent-grafts' implantation was successfully completed. No major type I endoleak was found in the immediate post-deployment angiography.


It is easy to apply this patient-tailored θ-AATA measuring method in clinical practice. This more precise measurement is benefit for more reasonable treatment strategy planning, more precise deployment, and therefore a better outcome.


Aortic dissection (AD); aortic arch angle; endoleak; endovascular therapy; endovascular treatment; proximal landing zone (PLZ)

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

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