Tracking False Lumen Remodeling with AI: A Variational Autoencoder Approach After Frozen Elephant Trunk Surgery

Objective: False lumen (FL) thrombosis plays a key role in aortic remodeling after Frozen Elephant Trunk (FET) surgery, yet current imaging assessments are limited to categorical classifications. This study aimed to evaluate an unsupervised artificial intelligence (AI) algorithm based on a variational autoencoder (VAE) for automated, continuous quantification of FL thrombosis using serial computed tomography angiography (CTA). Methods: In this retrospective study, a VAE model was applied to axial CTA slices from 30 patients with aortic dissection who underwent FET surgery. The model encoded each image into a structured latent space, from which a continuous "thrombus score" was developed and derived to quantify the extent of FL thrombosis. Thrombus scores were compared between postoperative and follow-up scans to assess individual remodeling trajectories. Results: The VAE successfully encoded anatomical features of the false lumen into a structured latent space, enabling unsupervised classification of thrombus states. A continuous thrombus score was derived from this space, allowing slice-by-slice quantification of thrombus burden across the aorta. The algorithm demonstrated robust reconstruction accuracy and consistent separation of fully patent, partially thrombosed, and completely thrombosed lumen states without the need for manual annotation. Across the cohort, 50% of patients demonstrated an increase in thrombus score over time, 40% a decrease, and 10% remained unchanged. Despite these individual differences, no statistically significant change in overall thrombus burden was observed at the group level (p = 0.82), emphasizing the importance of individualized longitudinal assessment. Conclusions: The VAE-based method enables reproducible, annotation-free quantification of FL thrombosis and captures patient-specific remodeling patterns. This approach may enhance post-FET surveillance and supports the integration of AI-driven tools into personalized aortic imaging workflows.