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Morphologic predictors of aortic expansion in chronic type B aortic dissection.

Abstract：

AIM:To identify morphologic factors affecting aortic expansion in patients with uncomplicated type B aortic dissections. METHODS:Computed tomography data of 24 patients (18 male; median age: 61 years), diagnosed with acute uncomplicated type B aortic dissections between 2002 and 2013, were retrospectively reviewed. All patients had at least two computed tomography angiography scans and six months of uneventful follow-up. Computed tomography scans were assessed by two independent readers with regard to presence and number of entry tears. Thoracic and abdominal aortic diameters were derived using image processing software. RESULTS:Twenty-two of 24 patients showed aortic expansion over a median computed tomography angiographic follow-up of 33.2 months. Annual rates showed an increase of 1.7 mm for total aortic diameter, 2.1 mm for the false and a decrease of -0.4 mm for the true lumen. In three patients (12.5%), aortic diameter exceeded 60 mm during follow-up, and all three patients underwent thoracic endovascular aortic repair. Patients with a maximum aortic diameter <4 cm at baseline showed a significantly higher expansion rate compared to cases with an initial maximum aortic diameter of ≥4 cm (p=0.0471). A median of two entries (range: 1-5) was recognized per patient. Presence of more than two entry tears (n = 13) was associated with faster overall diameter expansion (mean annual rates: 2.18 mm vs. 1.16 mm; p = 0.4556), and decrease of the cross-sectional surface of the true lumen over time (annual rate for > 2 entries vs. ≤2 entries: -7.8 mm2 vs. +37.5 mm2; p = 0.0369). Median size of entry tears was 12 mm (range: 2-53 mm). CONCLUSIONS:The results presented herein suggest that uncomplicated type B aortic dissection patients with more than two entry tears and/or an initial maximum aortic diameter of<4 cm are at risk for aortic dilatation and, therefore, may require stricter follow-up including the possible need for early intervention.

journal_name

Vascular

journal_title

Vascular

authors

Kotelis D,Grebe G,Kraus P,Müller-Eschner M,Bischoff M,von Tengg-Kobligk H,Böckler D

doi

10.1177/1708538115591941

subject

Has Abstract

pub_date

2016-04-01 00:00:00

pages

187-93

issue

eissn

1708-5381

issn

1708-539X

pii

1708538115591941

journal_volume

pub_type

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Morphologic predictors of aortic expansion in chronic type B aortic dissection.