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Acute Limited Intimal Tears of the Thoracic Aorta.

Abstract：

BACKGROUND:Limited intimal tears (LITs) of the aorta (Class 3 dissection variant) are the least common form of aortic pathology in patients presenting with acute aortic syndrome (AAS). LITs are difficult to detect on imaging and may be underappreciated. OBJECTIVES:This study sought to describe the frequency, pathology, treatment, and outcome of LITs compared with other AAS, and to demonstrate that LITs can be detected pre-operatively by contemporary imaging. METHODS:The authors retrospectively reviewed 497 patients admitted for 513 AAS events at a single academic aortic center between 2003 and 2012. AAS were classified into classic dissection (AD), intramural hematoma, LIT, penetrating atherosclerotic ulcer, and rupturing thoracic aortic aneurysm. The prevalence, pertinent risk factors, and detailed imaging findings with surgical and pathological correlation of LITs are described. Management, early outcomes, and late mortality are reported. RESULTS:Among 497 patients with AAS, the authors identified 24 LITs (4.8% of AAS) in 16 men and 8 women (17 type A, 7 type B). Patients with LITs were older than those with AD, and type A LITs had similarly dilated ascending aortas as type A AD. Three patients presented with rupture. Eleven patients underwent urgent surgical aortic replacement, and 2 patients underwent endovascular repair. Medial degeneration was present in all surgical specimens. In-hospital mortality was 4% (1 of 24), and in total, 5 patients with LIT died subsequently at 1.5 years (interquartile range [IQR]: 0.3 to 2.5 years). Computed tomography imaging detected all but 1 LIT, best visualized on volume-rendered images. CONCLUSIONS:LITs are rare acute aortic lesions within the dissection spectrum, with similar presentation, complications, and outcomes compared with AD and intramural hematoma. Awareness of this lesion allows pre-operative diagnosis using high-quality computed tomography angiography.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Chin AS,Willemink MJ,Kino A,Hinostroza V,Sailer AM,Fischbein MP,Mitchell RS,Berry GJ,Miller DC,Fleischmann D

doi

10.1016/j.jacc.2018.03.531

subject

Has Abstract

pub_date

2018-06-19 00:00:00

pages

2773-2785

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(18)34537-6

journal_volume

pub_type

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Acute Limited Intimal Tears of the Thoracic Aorta.