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Marway PS, Campello Jorge CA, Tjahjadi N, Baker TJ, Mistelbauer G, Baeumler K, Hinostroza V, Higashigaito K, Mastrodicasa D, Masotti M, Nordsletten D, Patel HJ, Fleischmann D, Burris NS. Early three-dimensional growth in uncomplicated type B aortic dissection is associated with long-term outcomes. J Vasc Surg 2024:S0741-5214(24)01819-6. [PMID: 39222827 DOI: 10.1016/j.jvs.2024.08.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/22/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Late adverse events (LAEs) are common among initially uncomplicated type B aortic dissection (uTBAD); however, identifying those patients at highest risk of LAEs remains a significant challenge. Early false lumen (FL) growth has been suggested to increase risk, but confident determination of growth is often hampered by error in two-dimensional clinical measurements. Semi-automated three-dimensional (3D) mapping of aortic growth, such as by vascular deformation mapping (VDM), can potentially overcome this limitation using computed tomography angiograms (CTA). We hypothesized that FL growth in the early pre-dissection phase by VDM can accurately predict LAEs. METHODS We performed a two-center retrospective study of patients with uTBAD, with paired CTAs in the acute (1-14 days) and subacute/early chronic (1-6 months) periods. VDM analysis was used to map 3D growth. Standard clinical CT measures (ie, aortic diameters, tear characteristics) were also collected. Multivariate analysis was conducted using a decision tree and Cox proportional hazards model. LAEs were defined as aneurysmal FL (>55 mm); rapid growth (>5 mm within 6 months); aorta-specific mortality, rupture, or re-dissection. RESULTS A total of 107 (69% male) patients with uTBAD initially met inclusion criteria with a median follow-up of 7.3 years (interquartile range [IQR], 4.7-9.9 years). LAEs occurred in 72 patients (67%) at 2.5 years (IQR, 0.7-4.8 years) after the initial event. A multivariate decision tree model identified VDM growth (>2.1 mm) and baseline diameter (>42.7 mm) as optimal predictors of LAEs (area under the receiver operating characteristic curve = 0.94), achieving an 87% accuracy (sensitivity of 93%, specificity of 76%) after leave-one-out validation. Guideline reported high-risk features were not significantly different between groups. CONCLUSIONS Early growth of the FL in uTBAD was the best tested indicator for LAEs and improves upon the current gold-standard of baseline diameter in selecting patients for early prophylactic thoracic endovascular aortic repair.
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Affiliation(s)
| | | | - Nicasius Tjahjadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI
| | - Timothy J Baker
- Department of Radiology, University of Michigan, Ann Arbor, MI
| | | | | | | | | | - Domenico Mastrodicasa
- Department of Radiology, Stanford University, Stanford, CA; Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Maria Masotti
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - David Nordsletten
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI
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Afifi RO, Mussa FF. Navigating clinical appropriateness: A review of management strategies for type B aortic dissection. Semin Vasc Surg 2024; 37:240-248. [PMID: 39152002 DOI: 10.1053/j.semvascsurg.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 08/19/2024]
Abstract
Aortic dissection is a catastrophic, life-threatening event. Its management depends on the anatomic location of the intimal tear (type A v B) and the clinical presentation in type B aortic dissection. In this article, the current evidence supporting clinical practice, gaps in knowledge, and the need for more rigorous research and higher-quality studies are reviewed.
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Affiliation(s)
- Rana O Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, 6400 Fannin Street, Suite 2850, Houston, TX 77030.
| | - Firas F Mussa
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, 6400 Fannin Street, Suite 2850, Houston, TX 77030
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3
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Kakehi K, Ueno M, Kawamura T, Yamada N, Takahashi K, Fujita K, Yasuda M, Matsumura K, Miyoshi T, Mizutani K, Takase T, Sakaguchi G, Nakazawa G. Prognostic impact of early aortic volume changes at hospital discharge in patients with acute type B aortic dissection. J Cardiol 2024; 83:49-56. [PMID: 37591338 DOI: 10.1016/j.jjcc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Early prediction of aorta-related events is important for determining subsequent treatment strategies in patients with acute aortic dissection. However, most studies evaluated long-term aortic growth rates by annual assessment. The purpose of our study was to determine whether the in-hospital growth rate of aortic volume was associated with aorta-related events. METHODS We studied 116 patients with uncomplicated type B acute aortic dissection. We analyzed whether changes in aortic volume were associated with aorta-related events during a 5-year follow-up. According to the growth rate from admission to discharge, patients were divided into two groups: Increase >0 (aortic volume: n = 59, aortic diameter: n = 43) and Reduction ≤0 (aortic volume: n = 57, aortic diameter: n = 73) in maximum aortic diameter or aortic volume. The primary endpoint was the discriminative ability of the growth rate of aortic volume for aorta-related events. RESULTS According to the evaluation of aortic volume changes, the Increase group had significantly higher aorta-related event rates than those in the Reduction group (49.2 % vs. 3.5 %, respectively; p < 0.001). Receiver operating characteristics analysis showed that the growth rate of aortic volume had a clearly useful discrimination, with an area under the curve of 0.84, whereas the discriminative ability of the growth rate of maximum aortic diameter was poor (area under the curve: 0.53). Multivariate analysis showed that the growth rate of aortic volume from admission to discharge was an independent predictor of aorta-related events (hazard ratio, 26.3; 95 % confidence interval, 2.04-286.49; p = 0.001). CONCLUSIONS In-hospital evaluation of aortic volume was helpful to predict long-term aorta-related events in patients with uncomplicated type B acute aortic dissection.
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Affiliation(s)
- Kazuyoshi Kakehi
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Masafumi Ueno
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Takayuki Kawamura
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Nobuhiro Yamada
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Kuniaki Takahashi
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Kosuke Fujita
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Masakazu Yasuda
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Koichiro Matsumura
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Tatsuya Miyoshi
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Kazuki Mizutani
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Toru Takase
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Gaku Nakazawa
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Osakasayama, Japan.
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4
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Pitcher GS, Newhall KA, Stoner MC, Mix DS. Gore TAG thoracic branch endograft for treatment of a subacute type B aortic dissection complicated by rupture. J Vasc Surg Cases Innov Tech 2023; 9:101193. [PMID: 37274439 PMCID: PMC10238452 DOI: 10.1016/j.jvscit.2023.101193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/30/2023] [Indexed: 06/06/2023] Open
Abstract
An 80-year-old man presented with a subacute zone 3-5 type B aortic dissection complicated by rupture and visceral and lower extremity malperfusion. He underwent emergent zone 2 repair with a Gore TAG thoracic branch endograft with inclusion of the left subclavian artery for a dominant left vertebral artery. The patient's postoperative course was uncomplicated. Type B aortic dissections can be anatomically complex, and rupture is a rare complication in the subacute phase. We report the novel use of a Gore TAG thoracic branch endograft for the management of type B aortic dissection complicated by rupture and demonstrate its feasibility for patients with type B aortic dissection complicated by rupture.
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Affiliation(s)
- Grayson S. Pitcher
- Correspondence: Grayson S. Pitcher, MD, Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642.
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5
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Bashir M, Tan SZ, Jubouri M, Coselli J, Chen EP, Mohammed I, Velayudhan B, Sadeghipour P, Nienaber C, Awad WI, Slisatkorn W, Wong R, Piffaretti G, Mariscalco G, Bailey DM, Williams I. Uncomplicated Type B Aortic Dissection: Challenges in Diagnosis and Categorisation. Ann Vasc Surg 2023:S0890-5096(23)00223-6. [PMID: 37075834 DOI: 10.1016/j.avsg.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Acute type B aortic dissection (TBAD) is a rare disease that is likely under-diagnosed in the UK. As a progressive, dynamic clinical entity, many patients initially diagnosed with uncomplicated TBAD deteriorate, developing end-organ malperfusion and aortic rupture (complicated TBAD). An evaluation of the binary approach to the diagnosis and categorisation of TBAD is needed. METHODS A narrative review of the risk factors predisposing patients to progression from unTBAD to coTBAD was undertaken. RESULTS Key high-risk features predispose the development of complicated TBAD, such as maximal aortic diameter > 40 mm and partial false lumen thrombosis. CONCLUSION An appreciation of the factors that predispose to complicated TBAD would aid clinical decision-making surrounding TBAD.
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Affiliation(s)
- Mohamad Bashir
- Vascular and Endovascular Surgery, Health Education and Improvement Wales, Velindre University NHS Trust, Wales, UK.
| | - Sven Zcp Tan
- Barts and The London School of Medicine, Queen Mary University of London, UK
| | | | - Joseph Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina
| | - Idhrees Mohammed
- Institute of Cardiac and Aortic Disorders, SRM Institutes for Medical Sciences, SIMS Hospital, Chennai, India
| | - Bashi Velayudhan
- Institute of Cardiac and Aortic Disorders, SRM Institutes for Medical Sciences, SIMS Hospital, Chennai, India
| | - Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Christoph Nienaber
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Wael I Awad
- Department of Cardiothoracic Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Worawong Slisatkorn
- Division of Cardio-Thoracic Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Randolph Wong
- Department of Surgery, Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Gabrielle Piffaretti
- Vascular Surgery - Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, UK
| | - Ian Williams
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, UK
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Oberhuber A, Raddatz A, Betge S, Ploenes C, Ito W, Janosi RA, Ott C, Langheim E, Czerny M, Puls R, Maßmann A, Zeyer K, Schelzig H. Interdisciplinary German clinical practice guidelines on the management of type B aortic dissection. GEFASSCHIRURGIE 2023; 28:1-28. [PMCID: PMC10123596 DOI: 10.1007/s00772-023-00995-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 08/13/2023]
Affiliation(s)
- A. Oberhuber
- German Society of Vascular Surgery and Vascular Medicine (DGG); Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany
| | - A. Raddatz
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI); Department of Anaesthesiology, Critical Care and Pain Medicine, Saarland University Hospital, Homburg, Germany
| | - S. Betge
- German Society of Angiology and Vascular Medicine (DGG); Department of Internal Medicine and Angiology, Helios Hospital Salzgitter, Salzgitter, Germany
| | - C. Ploenes
- German Society of Geriatrics (DGG); Department of Angiology, Schön Klinik Düsseldorf, Düsseldorf, Germany
| | - W. Ito
- German Society of Internal Medicine (GSIM) (DGIM); cardiovascular center Oberallgäu Kempten, Hospital Kempten, Kempten, Germany
| | - R. A. Janosi
- German Cardiac Society (DGK); Department of Cardiology and Angiology, University Hospital Essen, Essen, Germany
| | - C. Ott
- German Society of Nephrology (DGfN); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Hypertension, Paracelsus Medical University, Nürnberg, Germany
| | - E. Langheim
- German Society of prevention and rehabilitation of cardiovascular diseaese (DGPR), Reha Center Seehof, Teltow, Germany
| | - M. Czerny
- German Society of Thoracic and Cardiovascular Surgery (DGTHG), Department University Heart Center Freiburg – Bad Krozingen, Freiburg, Germany
- Albert Ludwigs University Freiburg, Freiburg, Germany
| | - R. Puls
- German Radiologic Society (DRG); Institute of Diagnostic an Interventional Radiology and Neuroradiology, Helios Klinikum Erfurt, Erfurt, Germany
| | - A. Maßmann
- German Society of Interventional Radiology (DeGIR); Department of Diagnostic an Interventional Radiology, Saarland University Hospital, Homburg, Germany
| | - K. Zeyer
- Marfanhilfe e. V., Weiden, Germany
| | - H. Schelzig
- German Society of Surgery (DGCH); Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
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7
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Wang Q, Guo X, Brooks M, Chuen J, Poon EKW, Ooi A, Lim RP. MRI in CFD for chronic type B aortic dissection: Ready for prime time? Comput Biol Med 2022; 150:106138. [PMID: 36191393 DOI: 10.1016/j.compbiomed.2022.106138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/31/2022] [Accepted: 09/18/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Better tools are needed for risk assessment of Type B aortic dissection (TBAD) to determine optimal treatment for patients with uncomplicated disease. Magnetic resonance imaging (MRI) has the potential to inform computational fluid dynamics (CFD) simulations for TBAD by providing individualised quantification of haemodynamic parameters, for assessment of complication risks. This systematic review aims to present an overview of MRI applications for CFD studies of TBAD. METHODS Following PRISMA guidelines, a search in Medline, Embase, and the Scopus Library identified 136 potentially relevant articles. Studies were included if they used MRI to inform CFD simulation in TBAD. RESULTS There were 20 articles meeting the inclusion criteria. 19 studies used phase contrast MRI (PC-MRI) to provide data for CFD flow boundary conditions. In 12 studies, CFD haemodynamic parameter results were validated against PC-MRI. In eight studies, geometric models were developed from MR angiography. In three studies, aortic wall or intimal flap motion data were derived from PC/cine MRI. CONCLUSIONS MRI provides complementary patient-specific information in CFD haemodynamic studies for TBAD that can be used for personalised care. MRI provides structural, dynamic and flow data to inform CFD for pre-treatment planning, potentially advancing its integration into clinical decision-making. The use of MRI to inform CFD in TBAD surgical planning is promising, however further validation and larger cohort studies are required.
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Affiliation(s)
- Qingdi Wang
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - Xiaojing Guo
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Mark Brooks
- Department of Radiology, Austin Health, Heidelberg, VIC, 3084, Australia; School of Medicine, Deakin University, Melbourne, Australia
| | - Jason Chuen
- Department of Surgery, Austin Health, Heidelberg, VIC, 3084, Australia; Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Fitzroy, VIC, 3065, Australia
| | - Eric K W Poon
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Fitzroy, VIC, 3065, Australia
| | - Andrew Ooi
- Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Ruth P Lim
- Department of Radiology, Austin Health, Heidelberg, VIC, 3084, Australia; Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Fitzroy, VIC, 3065, Australia; Department of Radiology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
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8
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CHEN B, WANG J. Impact and risk factors associated with false lumen thrombus status within stent segments of type B aortic dissection after endovascular repair. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.23736/s1824-4777.22.01541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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9
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Jubouri M, Patel R, Tan SZCP, Al-Tawil M, Bashir M, Bailey DM, Williams IM. Fate and Consequences of the False Lumen after TEVAR in Type B Aortic Dissection. Ann Vasc Surg 2022:S0890-5096(22)00616-1. [PMID: 36309167 DOI: 10.1016/j.avsg.2022.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Type B aortic dissection (TBAD) occurs due to an entry tear in the intimal layer of the aorta distal to the origin of the left subclavian artery where blood enters the newly formed false lumen (FL) and extends distally or proximally to form a dissection over an indeterminate length of the aorta which, over time, may eventually rupture. Thoracic endovascular aortic repair (TEVAR) aims to seal off the entry tear proximally with the stent-graft, occluding the origin of the dissection and excluding the FL. Nevertheless, in some cases, the perfusion to the FL is maintained, hindering the aortic remodelling process and increasing the risk of aneurysmal degeneration and rupture, particularly in the abdominal aorta where evidence suggest that remodelling is slower. This review examines the long-term effects of a patent or partially thrombosed FL on clinical outcomes following TEVAR in TBAD, also highlighting the pathological processes behind negative aortic remodelling. Another aim of this review is to provide an overview and appraisal of the currently available techniques for managing a patent or partially thrombosed FL to prevent long-term morbidity occurring. METHODS A comprehensive literature search was performed using several search engines including PubMed, Ovid, Google Scholar, Scopus, and Embase to identify and extract relevant studies. RESULTS Evidence in the literature show that a partially thrombosed FL is more dangerous than a patent FL due to the occlusion of the distal re-entry tears, impeding outflow and increasing mean arterial and diastolic pressures, whereas the latter is decompressed via distal re-entry sites. FL thrombosis and satisfactory remodelling is sometimes achieved in as few as 40% of patients after TEVAR due to the maintained perfusion of the FL either at the level of the thoracic or abdominal aorta. However, although the thoracic aorta is predominantly covered by the TEVAR stent-graft, poorer remodelling and more dilation is seen in the abdominal aorta. Several techniques are available to embolize the FL, including the Provisional Extension to Induce Complete Attachment, Stent Assisted Balloon Induced Intimal Disruption and Relamination in Aortic Dissection Repair, candy-plug, and Knickerbocker techniques. CONCLUSIONS The management of TBAD is invariably TEVAR to seal off the proximal entry tear while extending the repair distally to completely exclude the FL. A risk of aortic wall dilatation distal to TEVAR stent-graft remains; hence, regular monitoring and accurate imaging are essential. At present, a patent FL can be treated using a range of different endovascular techniques.
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Feng H, Fu Z, Wang Y, Lai H, Zhang P. Volumetric Measurements Improve the Accuracy of Aortic Remodeling Prediction in Aortic Dissection. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1626-1629. [PMID: 36085693 DOI: 10.1109/embc48229.2022.9871555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Accessing aortic remodeling status through regular follow-ups is essential for acute type A aortic dissection patients undergone surgical treatment. Aortic remodeling status was usually determined using diameter or area measurements of the true and false lumen in specific anatomical slices of medical images. However, these indicators only represent partial information about the aorta and can hardly characterize the overall aorta situation. In this study, we included two types of morphology features collected from computed tomography angiography images to predict the aortic remodeling. One type is the volumetric measurements of the true and false lumen, which provide a better overall description of the aorta, and the other type is the volumetric measurements of the thrombus in false lumen and the patent false lumen, which present more detailed information of the dissection. Through progressively incorporating these measurements into the construction of the remodeling prediction model, we investigated the importance of the features that describe the overall situation and that characterize aortic internal details in remodeling prediction, especially the effect of quantitative thrombosis features. The results showed that with the inclusion of the two types of volume features, the prediction accuracy of the model increased, which proves that volumetric measurements of aortic dissection, especially the volume of thrombus, are of significant value in aortic remodeling prediction, and should be paid more attention on in clinical practice and research areas. Clinical Relevance-Demonstrating the importance of volumetric measurements of true and false lumen thrombus in false lumen and patent false lumen in the prediction of aortic remodeling.
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11
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Evangelista A, Pineda V, Guala A, Bijnens B, Cuellar H, Rudenick P, Sao-Aviles A, Ruiz A, Teixido-Tura G, Rodriguez-Lecoq R, Bellmunt S, Ferreira I, Rodríguez-Palomares J. False Lumen Flow Assessment by Magnetic Resonance Imaging and Long-Term Outcomes in Uncomplicated Aortic Dissection. J Am Coll Cardiol 2022; 79:2415-2427. [PMID: 35710193 DOI: 10.1016/j.jacc.2022.04.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Despite the absence of clinical complications after an acute aortic dissection (AD) with persistent patent false lumen (FL), a high risk for clinical events may persist. OBJECTIVES The aim of this study was to assess the natural evolution of noncomplicated AD and ascertain whether different FL flow patterns by magnetic resonance imaging (MRI) have independent prognostic value for AD-related events beyond established morphologic parameters. METHODS One hundred thirty-one consecutive patients, 78 with surgically treated type A dissections and 53 with medically treated type B dissections, were followed up prospectively after acute AD with persistent patent FL in the descending aorta. Maximum aortic diameter, true lumen compression, entry tear, and partial FL thrombosis by computed tomography were assessed. Systolic antegrade true lumen and FL flow volumes and diastolic antegrade and retrograde flows were analyzed by MRI during the first year after AD. RESULTS After a median follow-up period of 8.0 years (IQR: 4.6-10.9 years), 43 patients presented aorta-related events (25 died and 18 required endovascular treatment). FL systolic antegrade flow ≥30% with respect to total systolic antegrade flow and retrograde diastolic flow ≥80% with respect to total diastolic FL flow were predictors of aortic events. In multivariate analysis, aortic diameter >45 mm (HR: 2.91), type B dissection (HR: 2.44), and MRI flow pattern (HR: 16.87) were independent predictors of AD-related events. CONCLUSIONS High systolic antegrade flow volume in the FL with significant diastolic retrograde flow assessed by MRI and aortic diameter >45 mm identify patients with higher risk for complications in whom more aggressive management would be indicated.
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Affiliation(s)
- Arturo Evangelista
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Victor Pineda
- Institut de Diagnòstic per la Imatge, Hospital Vall d'Hebron, Barcelona, Spain
| | - Andrea Guala
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Hug Cuellar
- Institut de Diagnòstic per la Imatge, Hospital Vall d'Hebron, Barcelona, Spain
| | - Paula Rudenick
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Augusto Sao-Aviles
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Aroa Ruiz
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Gisela Teixido-Tura
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Rafael Rodriguez-Lecoq
- Department de Cirurgia Cardiaca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Sergi Bellmunt
- Department de Cirurgia Vascular, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Ignacio Ferreira
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jose Rodríguez-Palomares
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
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Geragotellis A, Al-Tawil M, Jubouri M, Tan SZCP, Williams I, Bashir M. Risk profile analysis of uncomplicated type B aortic dissection patients undergoing thoracic endovascular aortic repair: Laboratory and radiographic predictors. J Card Surg 2022; 37:2811-2820. [PMID: 35652486 DOI: 10.1111/jocs.16655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 04/22/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND There is emerging evidence to support pre-emptive thoracic endovascular aortic repair (TEVAR) intervention for uncomplicated type B aortic dissection (unTBAD). Pre-emptive intervention would be particularly beneficial in patients that have a higher baseline risk of progressing to complicated TBAD (coTBAD). There remain debate on the optimal clinical, laboratory, morphological, and radiological parameters, which would identify the highest-risk patients that would benefit most from pre-emptive TEVAR. AIM This review summarizes evidence on the clinical, laboratory, and morphological parameters that increase the risk profiles of unTBAD patients. METHODS A comprehensive literature search was carried out on multiple electronic databases including PubMed, EMBASE, Ovid, and Scopus to collate all research evidence on the clinical, laboratory, and morphological parameters that increase the risk profiles of unTBAD patients RESULTS: At present, there are no clear clinical guidelines using risk-stratification to inform the selection of unTBAD patients for TEVAR. However, there are noticeable literature trends that can assist with the identification of the most at-risk unTBAD patients. Patients are at particular risk when they have refractory pain and/or hypertension, elevated C-reactive protein (CRP), larger aortic diameter, and larger entry tears. These risks should be considered alongside factors that increase the procedural risk of TEVAR to create a well-balanced approach. Advances in biomarkers and imaging are likely to identify more pertinent parameters in the future to optimize the development of balanced, risk-stratified treatment protocols. CONCLUSION There are a variety of risk profiling parameters that can be used to identify the high-risk unTBAD patient, with novel biomarkers and imaging parameters emerging. Longer-term evidence verifying these parameters would be ideal. Further randomized controlled trials and multicentre registry analyses are also warranted to guide risk-stratified selection protocols.
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Affiliation(s)
| | | | - Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | - Sven Z C P Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ian Williams
- Department of Vascular Surgery, Heath Park, University Hospital of Wales, Cardiff, UK
| | - Mohamad Bashir
- Vascular & Endovascular Surgery, Health Education & Improvement Wales (HEIW), Velindre University NHS Trust, Cardiff, UK
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Li Z, Xu H, Armour CH, Guo Y, Xiong J, Xu X, Chen D. The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator. Front Bioeng Biotechnol 2022; 10:831903. [PMID: 35433660 PMCID: PMC9009393 DOI: 10.3389/fbioe.2022.831903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) is a common treatment for Stanford type B aortic dissection (TBAD). However, re-entry tears might be found distal to the stented region which transports blood between the true and false lumens. Sealing the re-entry tears, especially for the thoracic tears, could further reduce blood perfusion to the false lumen; however, it might also bring risks by re-intervention or surgery. Wise determination of the necessity to seal the re-entry tears is needed. In this study, patient-specific models of TBAD were reconstructed, and the modified models were established by virtually excluding the thoracic re-entries. Computational hemodynamics was investigated, and the variation of the functional index and first balance position (FBP) of the luminal pressure difference, due to the sealing of the re-entries, was reported. The results showed that the direction of the net flow through the unstented thoracic re-entries varied among cases. Excluding the re-entries with the net flow toward the false lumen may induce the FBP moving distally and the relative particle residence time increasing in the false lumen. This study preliminarily demonstrated that the hemodynamic status of the re-entry tears might serve as an indicator to the necessity of sealing. By quantifying the through-tear flow exchange and shift of FBP, one can predict the hemodynamic benefit by sealing the thoracic re-entries and thus wisely determine the necessity of further interventional management.
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Affiliation(s)
- Zhenfeng Li
- School of Life Science, Beijing Institute of Technology, Beijing, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Zhejiang, China
| | - Huanming Xu
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Chlöe Harriet Armour
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Yuze Guo
- School of Biomedical Engineering, University of Sydney, Sydney, NSW, Australia
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Jiang Xiong, ; Xiaoyun Xu,
| | - Xiaoyun Xu
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
- *Correspondence: Jiang Xiong, ; Xiaoyun Xu,
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Zhejiang, China
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Kinoshita T, Asai T, Suzuki T. Outer Media Thickness at False Lumen and Secondary Aortic Dilatation After Acute Aortic Dissection. Ann Thorac Surg 2022; 114:1646-1654. [PMID: 35292257 DOI: 10.1016/j.athoracsur.2022.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/20/2022] [Accepted: 02/28/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study measured the outer media thickness (OMT) at the false lumen by using microscopic images of specimens collected intraoperatively and assessed the impact of OMT on secondary dilatation of the downstream aorta. METHODS Of 238 patients undergoing surgical procedures for acute type A dissection between 2007 and 2016, 129 patients fulfilled the inclusion criteria for this study: DeBakey type I dissection with a patent false lumen, histopathologic examination of full-thickness aortic wall, and at least 1 follow-up computed tomographic scan at more than 3 months after surgical procedures. On average, 5.1 scans were obtained per patient, and median follow-up was 4.3 years. RESULTS Considerable variation was observed in OMT (median, 0.21 mm; range, 0.04-0.51 mm). The aortic diameter growth rate was inversely correlated with the OMT, and in the lowest tertile of OMT the aortic diameter dilated significantly faster in the first year than later and faster than in the other tertiles. Multivariable Fine-Gray analysis, with death as the competing risk, identified OMT as an independent variable for aortic-related events. Patients with OMT of 0.04 to 0.15 mm had a 3.54-fold higher risk of aortic-related events and those with 0.16 to 0.31 mm had a 1.56-fold higher risk of aortic-related events than did patients with OMT of 0.32 to 0.51 mm. Multivariable Cox regression analyses revealed OMT of 0.04 to 0.15 mm as an independent variable for all-cause mortality. CONCLUSIONS In patients with DeBakey type I aortic dissection with a patent false lumen, the growth rate of the distal residual dissecting aorta was inversely correlated with the OMT. The risk of aortic-related events was significantly higher in patients with OMT of 0.04 to 0.15 mm.
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Affiliation(s)
- Takeshi Kinoshita
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan; Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan.
| | - Tohru Asai
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan; Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Tomoaki Suzuki
- Division of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Japan
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15
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Singh S, Palanca JA, Austin NJ, Tan SZCP, Jubouri M, Bailey DM, Williams IM, Nienaber CA, Coselli JS, Bashir M. Criteria for endovascular intervention in type B aortic dissection. J Card Surg 2022; 37:987-992. [PMID: 35083781 DOI: 10.1111/jocs.16267] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of thoracic endovascular aortic repair (TEVAR) for the management of uncomplicated type B aortic dissection (un-TBAD) remains controversial. There is a lack of consensus over whether pre-emptive TEVAR should be carried out in patients with un-TBAD at risk of progression to complicated TBAD. We present a review of current evidence and seek to suggest criteria where endovascular intervention in un-TBAD may prove beneficial relative to pharmacotherapy alone. METHODS AND MATERIALS PubMed and Cochrane databases were searched using terms including: type B aortic dissection, risk factors, medical therapy, TEVAR, false lumen (FL) expansion, and mortality. Papers were selected based on title and abstract. RESULTS Optimal medical therapy remains the mainstay treatment for patients with un-TBAD, however, patients with un-TBAD present with varying degrees of disease progression risk. Factors such as age, aortic morphology, history of connective tissue disorders, FL thrombosis, and aortic branch involvement may potentiate progression from un-TBAD to complicated TBAD. Short- and long-term outcomes associated with TEVAR for TBAD remain promising. CONCLUSION Pre-emptive TEVAR may be beneficial in patients with un-TBAD presenting with the above factors, however, further prospective research into the optimal timing for TEVAR in un-TBAD is required.
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Affiliation(s)
- Sidhant Singh
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Joaquin A Palanca
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Natasha J Austin
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sven Z C P Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Ian M Williams
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, UK
| | | | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Mohamad Bashir
- Department of Vascular and Endovascular Surgery, Velindre University NHS Trust, Health Education and Improvement Wales, Wales, UK
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16
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Armour CH, Guo B, Saitta S, Pirola S, Liu Y, Dong Z, Xu XY. Evaluation and verification of patient-specific modelling of type B aortic dissection. Comput Biol Med 2022; 140:105053. [PMID: 34847383 DOI: 10.1016/j.compbiomed.2021.105053] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
Quantitative assessment of the complex hemodynamic environment in type B aortic dissection (TBAD) through computational fluid dynamics (CFD) simulations can provide detailed insights into the disease and its progression. As imaging and computational technologies have advanced, methodologies have been developed to increase the accuracy and physiological relevance of CFD simulations. This study presents a patient-specific workflow to simulate blood flow in TBAD, utilising the maximum amount of in vivo data available in the form of CT images, 4D-flow MRI and invasive Doppler-wire pressure measurements, to implement the recommended current best practice methodologies in terms of patient-specific geometry and boundary conditions. The study aimed to evaluate and verify this workflow through detailed qualitative and quantitative comparisons of the CFD and in vivo data. Based on data acquired from five TBAD patients, a range of essential model inputs was obtained, including inlet flow waveforms and 3-element Windkessel model parameters, which can be utilised in further studies where in vivo flow data is not available. Local and global analysis showed good consistency between CFD results and 4D-MRI data, with the maximum velocity in the primary entry tear differing by up to 0.3 m/s, and 80% of the analysed regions achieving moderate or strong correlations between the predicted and in vivo velocities. CFD predicted pressures were generally well matched to the Doppler-wire measurements, with some deviation in peak systolic values. Overall, this study presents a validated comprehensive workflow with extensive data for CFD simulation of TBAD.
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Affiliation(s)
- Chlöe H Armour
- Department of Chemical Engineering, Imperial College London, London, SW7 2AZ, UK
| | - Baolei Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Simone Saitta
- Department of Chemical Engineering, Imperial College London, London, SW7 2AZ, UK; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Selene Pirola
- Department of Chemical Engineering, Imperial College London, London, SW7 2AZ, UK
| | - Yifan Liu
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Zhihui Dong
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, SW7 2AZ, UK.
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17
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Cuellar-Calabria H, Burcet G, Roque A, Rodríguez-Palomares J, Teixidó G, Rodríguez R, Bellmunt S, Zebdi N, Reyes-Juárez J, Sao-Avilés A, Escobar M, Evangelista A. Differences in the Area of Proximal and Distal Entry Tears at CT Angiography Predict Long-term Clinical Outcomes in Aortic Dissection. Radiol Cardiothorac Imaging 2021; 3:e210029. [PMID: 34934947 DOI: 10.1148/ryct.2021210029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/28/2021] [Accepted: 08/16/2021] [Indexed: 01/16/2023]
Abstract
Purpose To identify entry tear variables that are related to adverse clinical events by using CT angiography (CTA) performed during the subacute phase of aortic dissection. Materials and Methods In this prospective study conducted from January 2000 to December 2013, participants with an aortic dissection with a patent false lumen and no comorbidities underwent CTA during the subacute phase. Participants were followed up for a survival analysis to assess the time to an adverse aortic event (AAE). The maximum aortic diameter (MAD), proximal and distal tear areas and difference between these areas, and partial false-lumen thrombosis were assessed by using Cox regression for adverse events. Results Seventy-two participants (mean age, 55 years ± 12 [standard deviation]; 55 men) were evaluated: 47 were surgically treated (type A aortic dissection) and 25 were medically treated (type B aortic dissection). Twenty-two participants had an AAE manifest during follow-up (9.22 years ± 5.78): There were 18 elective surgeries for aneurysmal degeneration, two emergent surgeries for acute aortic syndrome, and two aortic condition-related deaths. A categorical model composed of genetic aortic disease (GAD) (hazard ratio [HR], 3.4 [95% CI: 1.2, 9.9]; P = .02), MAD greater than 45 mm (HR, 6.1 [95% CI: 2.4, 15.8]; P < .001), and tear dominance (HR, 5.2 [95% CI: 2.1, 13]; P < .001), defined as an absolute tear area difference of greater than 1.2 cm2, was used to stratify participants into three risk groups: low, without any risk factors (57% [41 of 72] and 7% [three of 41] had events); intermediate, with one risk factor (31% [22 of 72] and 50% [11 of 22] had events); and high, with two or more risk factors (13% [nine of 72] and 89% [eight of nine] had events; log rank P < .001). Conclusion Tear dominance demonstrated at CTA performed in the subacute phase of aortic dissection was related to long-term adverse events. Participants without GAD, dominant tears, or MAD greater than 45 mm had conditions that were safely managed with optimal medical treatment and imaging follow-up.Keywords: CT Angiography, Vascular, Aorta, Dissection Supplemental material is available for this article. © RSNA, 2021See also commentary by Fleischmann and Burris in this issue.
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Affiliation(s)
- Hug Cuellar-Calabria
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Gemma Burcet
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Albert Roque
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - José Rodríguez-Palomares
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Gisela Teixidó
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Rafael Rodríguez
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Sergi Bellmunt
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Naoufal Zebdi
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - José Reyes-Juárez
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Augusto Sao-Avilés
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Manuel Escobar
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Arturo Evangelista
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
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Zhang J, Zhang Z, Fu L, Wang L, Yang Y, Wang H, Zhou B, Wang W, Zhang J, Xin S. Obstructive Sleep Apnoea in Stanford Type B Aortic Dissection Is Associated With Multiple Imaging Signs Related to Late Aortic Events. Front Cardiovasc Med 2021; 8:752763. [PMID: 34869658 PMCID: PMC8636812 DOI: 10.3389/fcvm.2021.752763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Obstructive sleep apnoea (OSA) is highly prevalent in patients with Stanford type B aortic dissection (TBAD). Few studies have evaluated the effects of OSA on vascular changes in TBAD patients. This study aimed to explore the effect of OSA on aortic morphological changes in TBAD patients and its relation to late aortic events (LAEs). Methods: This case-control study included 143 TBAD patients. The diameters of different parts of the aorta were measured based on computed tomography angiography (CTA). According to the apnoea-hypopnoea index (AHI), OSA was classified as mild (5 ≤ AHI ≤ 15), moderate (15 < AHI ≤ 30), or severe (AHI > 30). The false lumen (FL) status was evaluated and classified as partially thrombosed, patent, or completely thrombosed. Results: The OSA prevalence in TBAD patients was 64.3%, and image differences related to LAEs between TBAD patients with and without OSA included the maximum aortic diameter at onset (37.3 ± 3.9 vs. 40.3 ± 4.5 mm, p < 0.001), the FL diameter of the proximal descending thoracic aorta (16.0 ± 6.8 vs. 20.3 ± 4.7 mm, p < 0.001), and the proportion of the FL that was partially thrombosed (39.2 vs. 64.1%, p = 0.004). Additionally, in the multivariable analysis of patients with OSA, the risks of an aortic diameter ≥40 mm, a proximal descending aorta FL ≥ 22 mm and a partially thrombosed FL were 4.611 (95% CI: 1.796–11.838, p = 0.001), 2.544 (95% CI: 1.050–6.165, p = 0.039), and 2.565 (95% CI: 1.167–5.637, p = 0.019), respectively, after adjustment for confounding factors. Trend tests showed that the risks of an aortic diameter ≥40 mm and a partially thrombosed FL increased with increasing OSA severity. Conclusions: TBAD patients with moderate to severe OSA have aortic dilatation in different parts of the aorta. OSA is an independent risk factor for multiple imaging signs related to LAEs, suggesting that OSA is an important factor affecting the prognosis of TBAD patients.
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Affiliation(s)
- Jiawei Zhang
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Zhe Zhang
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Lingyu Fu
- Department of Clinical Epidemiology and Evidence Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Lei Wang
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Yu Yang
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Hao Wang
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Baosen Zhou
- Department of Clinical Epidemiology and Evidence Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Wei Wang
- Department of Respiratory Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Jian Zhang
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Shijie Xin
- Department of Vascular Surgery, The First Hospital of China Medical University, Shenyang, China
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Nugraha RA, Amshar M, Batubara EAD, Siddiq T, Indriani S, Adiarto S. Descending Aorta Diameters as Predictor of Late Adverse Outcomes in Patients with Uncomplicated Type B Aortic Dissection: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2021; 80:333-344. [PMID: 34780948 DOI: 10.1016/j.avsg.2021.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A subset of patients with uncomplicated type B aortic dissection (uTBAD) has been shown to possess higher risk of experiencing late adverse outcomes. Therefore, we conducted an analysis to investigate the role of descending aorta diameters, including total descending aorta diameter and false lumen diameter, as predictor of late adverse outcomes in patients with uTBAD. METHODS A systematic search was performed through Pubmed, ClinicalKey, ScienceDirect, and Cochrane Library to identify relevant studies. Our primary outcome was the composite late adverse events following their first episode of hospitalization. All meta-analyses were performed using Review Manager version 5.4. RESULTS A total of 2,339 (male 68.8%) patients from a total of 15 cohorts were included in our analysis. During follow-up period, there were 655 (27.3%) and 149 (6.3%) cases of late adverse events and mortality, respectively. Patients with higher initial descending aorta diameter were at higher risk of developing late adverse events (RR 2.99 [2.60, 3.44]; P < 0.001) and mortality (RR 3.15 [2.34, 4.25]; P <0.001) throughout follow-up period. Maximum false lumen diameter at the initial presentation seemed to significantly be associated with late adverse events (RR 1.87 [1.46, 2.39]; P <0.001) but not with mortality (RR 2.55 [0.81-8.00; P = 0.11). CONCLUSION Descending aorta diameters, particularly maximum initial descending aorta diameter, is a good and helpful predictor of late adverse outcomes in patients with uTBAD.
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Affiliation(s)
- Raka Aldy Nugraha
- Department of General Medicine, Universitas Indonesia Hospital, Depok, West Java, Indonesia.
| | - Mohamed Amshar
- Department of General Medicine, Universitas Indonesia Hospital, Depok, West Java, Indonesia
| | | | - Taofan Siddiq
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Suci Indriani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Suko Adiarto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Wu S, Cao C, Lun Y, Jiang H, Wang S, He Y, Sun J, Li X, He Y, Huang Y, Chen W, Xin S, Zhang J. Age-related differences in acute aortic dissection. J Vasc Surg 2021; 75:473-483.e4. [PMID: 34562571 DOI: 10.1016/j.jvs.2021.08.086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The present study investigated the differences in clinical characteristics, treatments, and outcomes of patients with acute aortic dissection (AAD) in different age groups. METHODS The present single-center retrospective study was conducted from August 2014 to August 2020. The patients were divided into three groups: age <45 years (young group), age 45 to 59 years (middle-age group), and age >59 years (elderly group). Type A (TAAD) and type B (TBAD) aortic dissection were evaluated separately using the latest definitions. RESULTS The mean age at onset was 52.4 years in our cohort of 602 patients. The young group included a large proportion of male patients (86%). The body mass index and body surface area were higher in the young group. The proportion of non-true lumen blood supply of branches on the abdominal aorta in the young group (27%-55%) was greater than that in the others. In the young group, the distal extent of dissection in 84% of TAAD and 89% of TBAD exceeded the abdominal aortic branch cluster (AABC) compared with 36% of TAAD and 58% of TBAD in the elderly group. The multivariate analysis revealed that age <45 years (odds ratio, 5.15; P < .001) and D-dimer level (odds ratio, 1.05; P = .001) were risk factors for intimal flap tear exceeding the AABC. The proportion of visceral and lower limb malperfusion increased from 4.8% to 36.9% as the intimal flap tear exceeded the AABC. CONCLUSIONS Compared with middle-age and elderly patients, young patients with AAD had two characteristics (ie, obesity and an intimal flap that had frequently exceeded the branches of the aorta). These two factors resulted in a greater proportion of non-true lumen blood supply, increased visceral and lower limb malperfusion, and an increase in potential associated risks.
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Affiliation(s)
- Song Wu
- Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Chenghao Cao
- Department of Radiology, The First Hospital, China Medical University, Shenyang, China
| | - Yu Lun
- Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Han Jiang
- Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Shiyue Wang
- Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Yuchen He
- Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Jianjian Sun
- Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Xin Li
- Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Yuzhen He
- Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Yinde Huang
- Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Wenbin Chen
- Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Shijie Xin
- Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China
| | - Jian Zhang
- Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China.
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21
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Miyoshi Y, Kaji S, Masumoto A, Kim K, Kitai T, Kinoshita M, Furukawa Y. Aortic enlargement in two weeks is associated with subsequent aortic events in patients with type B acute aortic syndrome. J Thorac Cardiovasc Surg 2021:S0022-5223(21)01363-5. [PMID: 34749934 DOI: 10.1016/j.jtcvs.2021.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/27/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether aortic enlargement in 2 weeks in patients with type B acute aortic syndrome is associated with aorta-related adverse events. METHODS This retrospective, single-center study included 183 patients who were diagnosed with uncomplicated type B acute aortic syndrome (classic aortic dissection and intramural hematoma) between 2010 and 2019 and had follow-up computed tomography at second or third week. Aortic diameter was measured at admission and at predischarge follow-up. Aorta-related adverse events were defined by a composite of aortic rupture, surgical or endovascular aortic repair, redissection, severe intestinal malperfusion, and aortic enlargement. RESULTS The patients whose aortic diameter enlarged ≥2 mm but <5 mm in 2 weeks were categorized as moderate aortic enlargement group. During follow-up, 51 patients (28%) had aorta-related adverse events and 36 patients (20%) had moderate aortic enlargement. Patients with moderate aortic enlargement showed lower aorta-related event-free survival rates than those without moderate enlargement (48 ± 9% vs 90 ± 3% at 1 year, P < .001). On multivariable analysis, moderate aortic enlargement (subhazard ratio, 3.64; 95% confidence interval, 2.08-6.35; P < .001) and aortic diameter ≥40 mm at admission (subhazard ratio, 2.96; 95% confidence interval, 1.60-5.48; P < .001) were associated with aorta-related adverse events. CONCLUSIONS Moderate aortic enlargement in 2 weeks is a significant risk factor of aorta-related adverse events in patients with uncomplicated type B acute aortic syndrome. Patients with moderate aortic enlargement should be followed up carefully and may be candidates for subsequent endovascular treatment.
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Affiliation(s)
- Yutaro Miyoshi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Akiko Masumoto
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Makoto Kinoshita
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
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22
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Howard C, Sheridan J, Picca L, Reza S, Smith T, Ponnapalli A, Calow R, Cross O, Iddawela S, George M, Livra Dias D, Srinivasan A, Munir W, Bashir M, Idhrees M. TEVAR for complicated and uncomplicated type B aortic dissection-Systematic review and meta-analysis. J Card Surg 2021; 36:3820-3830. [PMID: 34310731 DOI: 10.1111/jocs.15827] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Type B aortic dissection (TBAD), is defined as a dissection involving the aorta distal to left subclavian artery with the ascending aorta and the aortic arch not affected. TBAD is classified due to the time frame and presence of complications. Complicated TBAD (co-TBAD) patients have a greater mortality rate than uncomplicated TBAD (un-TBAD) and thoracic endovascular aortic repair (TEVAR) is considered the gold-standard intervention for these clinical challenges. METHODS We undertook a systematic review of the literature regarding TEVAR intervention in co-TBAD and un-TBAD. A comprehensive search was undertaken across four major databases and was evaluated and assessed until June 2020. RESULTS A total of 16,104 patients were included in the study (7772 patients co-TBAD and 8352 un-TBAD). A significantly higher proportion of comorbidities were seen in co-TBAD patients compared with un-TBAD. Acute dissection was more frequent in the co-TBAD group (73.55% vs. 66.91%), while chronic dissection was more common in un-TBAD patients (33.8% vs. 70.73%). Postprocedure stroke was higher in co-TBAD (5.85% vs. 3.92%; p < .01), while postprocedural renal failure was higher in un-TBAD patients (7.23 vs. 11.38%; p < .01). No difference was observed in in-hospital mortality however the 30 days mortality was higher in the co-TBAD group. One-year survival was higher in the uncomplicated group but this difference was not observed in the 5-year survival. CONCLUSION In our analysis we can appreciate that despite significantly higher comorbidities in the co-TBAD cohort, there was no difference in in-hospital mortality between the two groups and the 5-year survival did not have any difference.
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Affiliation(s)
- Callum Howard
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Jonathan Sheridan
- Academic Unit of Medical Education, The University of Sheffield, Sheffield, UK
| | - Leonardo Picca
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Sihab Reza
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Tristan Smith
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Anuradha Ponnapalli
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Rachel Calow
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Olivia Cross
- School of Medicine, Keele University, Staffordshire, UK
| | - Sashini Iddawela
- Department of Respiratory Medicine, University Hospitals Birmingham, Birmingham, UK
| | - Melvin George
- Clinical Pharmacology, SRM Medical College Hospital, Kancheepuram, Tamil Nadu, India
| | - Deidre Livra Dias
- Senior Medical Reviewer, Cognizant Technology Solutions, Pune, India
| | - Anand Srinivasan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Wahaj Munir
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mohammad Bashir
- Vascular and Endovascular Surgery, NHS Wales Health Education and Improvement, Cardiff, UK
| | - Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Vadapalani, Chennai, India
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23
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Yu B, Li T, Liu H. Retrospective analysis of factors associated with aortic remodeling in patients with Stanford type B aortic dissection after thoracic endovascular aortic repair. J Cardiothorac Surg 2021; 16:190. [PMID: 34233714 PMCID: PMC8262045 DOI: 10.1186/s13019-021-01571-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/28/2021] [Indexed: 01/16/2023] Open
Abstract
Objective Acute aortic dissection is a life-threatening condition. Thoracic endovascular aortic repair (TEVAR), together with optimized medical treatment, is currently the first line treatment for acute Stanford type B aortic dissection. TEVAR can close the entry tear and reduce mortality. Aortic remodeling after TEVAR can directly affect the patient’s long-term prognosis. The factors that influence aortic remodeling have, however, received insufficient clinical attention and remain unclear. It is very important to identify these factors. Methods A total of 100 patients were continuously enrolled from 2011 to 2018 in 2 centers. Relevant data, including time from hospital admission to surgery, medicine use and aortic computed tomography angiography images obtained before and 6 months after surgery were collected. Patients were divided into favorable and adverse aortic remodeling groups, according to the degree of aortic remodeling. Analysis of variance and the chi-square test were performed using SPSS software to compare differences between groups and to determine the factors that influence postoperative aortic remodeling. Results The proportion of single-stent implantations was higher in the favorable remodeling group than in the adverse remodeling group (79.5% vs. 53.8% in distal end of stent-graft level and 81.3% vs. 56.4% in diaphragm level, respectively, p < 0.05). The earlier the TEVAR procedure was performed, the better the aortic remodeling (3.4 days vs. 4.8 days in distal stent graft levels, and 3.6 days vs. 4.9 days in diaphragm level, respectively, p < 0.05), the presence of residual distal entry tears in the abdominal aorta also improved aortic remodeling after TEVAR (85.7% vs. 55.1% in the celiac trunk level, and 92.0% vs. 48.9% in the right renal artery level, respectively, p < 0.05). Conclusion Single stent-graft implantation and early surgery were associated with favorable aortic remodeling. Distal entry tears were also conducive to aortic remodeling after surgery for aortic dissection. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01571-2.
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Affiliation(s)
- Biao Yu
- The Second Clinical Medical College, Jinan University, 1017 Dongmen North Road, Shenzhen, 518020, Guangdong, China.,The First Affiliated Hospital, Southern University of Science and Technology (Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital), Shenzhen, 518020, Guangdong, China
| | - Tangzhiming Li
- The Second Clinical Medical College, Jinan University, 1017 Dongmen North Road, Shenzhen, 518020, Guangdong, China.,The First Affiliated Hospital, Southern University of Science and Technology (Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital), Shenzhen, 518020, Guangdong, China
| | - Huadong Liu
- The Second Clinical Medical College, Jinan University, 1017 Dongmen North Road, Shenzhen, 518020, Guangdong, China. .,The First Affiliated Hospital, Southern University of Science and Technology (Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital), Shenzhen, 518020, Guangdong, China.
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24
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Xie E, Yang F, Liu Y, Xue L, Fan R, Xie N, Chen L, Liu J, Luo J. Timing and Outcome of Endovascular Repair for Uncomplicated Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2021; 61:788-797. [PMID: 33846073 DOI: 10.1016/j.ejvs.2021.02.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 12/02/2020] [Accepted: 02/19/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study aimed to determine the effect of intervention timing, from symptom onset to thoracic endovascular aortic repair (TEVAR), on early and late outcomes in high risk patients with uncomplicated type B aortic dissection (uTBAD). METHODS The study retrospectively evaluated 267 uTBAD patients with high risk radiographic features who underwent pre-emptive TEVAR during the acute and subacute periods. Demographics, comorbidities, pre-operative imaging features, peri-procedural details, and follow up outcomes were analysed. RESULTS Among the 267 pre-emptive TEVARs for high risk uTBAD, 130 were performed in the acute phase (1-14 days); and 137 in the subacute phase (15-90 days), from initial presentation. The mean age was 55.9 ± 11.0 years and 222 (83.1%) were men. The 30 day mortality rate in the acute group was five times higher than that in the subacute group (3.8% vs. 0.7%), although without statistically significant difference (p = .11). No statistically significant difference in 30 day outcomes (aortic rupture, retrograde type A dissection [RTAD], immediate type Ia endoleak, stroke, spinal cord ischaemia, and re-intervention) was noted (p > .05 for each). Of note, aortic rupture, RTAD, and disabling stroke were observed only in the acute group. Multivariable logistic analyses showed that intervention timing was not associated with 30 day outcomes. The median clinical follow up was 48.2 ± 25.9 months (range 1 - 106 months). There were no significant differences in all cause mortality, dissection related death, late intervention, or aortic related late events among timing cohorts (p > .05 for each). Furthermore, aortic remodelling, by analysing the flow status of the false lumen and evaluation of aortic diameters, either at the thoracic aorta level or the abdominal aorta level, was similar between the two groups. Multivariable Cox analyses showed that intervention timing was not associated with late outcomes. CONCLUSION The present study indicates that TEVAR for high risk uTBAD in the acute phase was associated with a trend toward higher rates of early complications, while the long term outcomes were comparable with those of the subacute phase.
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Affiliation(s)
- Enmin Xie
- Department of Cardiology, Vascular Centre, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Fan Yang
- Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Yuan Liu
- Department of Cardiology, Vascular Centre, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Ling Xue
- Department of Cardiology, Vascular Centre, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Ruixin Fan
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Nianjin Xie
- Department of Cardiology, Vascular Centre, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Lyufan Chen
- Department of Cardiology, Vascular Centre, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Jitao Liu
- Department of Cardiology, Vascular Centre, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Jianfang Luo
- Department of Cardiology, Vascular Centre, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.
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Malaisrie SC, Mehta CK. Updates on Indications for TEVAR in Type B Aortic Dissection. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:495-501. [DOI: 10.1177/1556984520961037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S. Chris Malaisrie
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, USA
| | - Christopher K. Mehta
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, USA
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Kazimierczak A, Rynio P, Jędrzejczak T, Samad R, Rybicka A, Gutowski P. Aortic Remodeling After Extended PETTICOAT Technique in Acute Aortic Dissection Type III B. Ann Vasc Surg 2020; 66:183-192. [DOI: 10.1016/j.avsg.2019.10.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/25/2019] [Accepted: 10/05/2019] [Indexed: 11/30/2022]
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27
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Hossack M, Patel S, Gambardella I, Neequaye S, Antoniou GA, Torella F. Endovascular vs. Medical Management for Uncomplicated Acute and Sub-acute Type B Aortic Dissection: A Meta-analysis. Eur J Vasc Endovasc Surg 2020; 59:794-807. [DOI: 10.1016/j.ejvs.2019.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 07/07/2019] [Accepted: 08/02/2019] [Indexed: 12/29/2022]
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28
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Shah A, Gupta N, Gewertz BL, Azizzadeh A. TEVAR for high risk patients with uncomplicated type B aortic dissection: a paradigm shift. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.20.01450-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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29
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Shen Y, Zhang S, Zhu G, Chen Y, Chen Z, Jing Z, Lu Q. Risk factors of distal segment aortic enlargement after complicated type B aortic dissection. J Interv Med 2019; 2:154-159. [PMID: 34805893 PMCID: PMC8562164 DOI: 10.1016/j.jimed.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives Distal segment aortic enlargement (DSAE) is a common complication that influences the long-term prognosis of type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR). In this study, a multivariate analysis was performed to find potential factors predictive of DSAE. Methods A single-center retrospective study was performed from 1999 to 2016. Included in the study were complicated TBAD patients who underwent TEVAR with uncovered residual tears. Based on the diameter of the distal segment of the uncovered aorta, we assigned patients to an enlargement group and a non-enlargement group. Data extracted from the medical records included demographic and clinical characteristics and follow-up computed tomography angiography data. The primary endpoints were the all-cause mortality and the presumably aortic-related events that required reintervention during the follow-up period. Results For the 333 patients, all-cause mortality was 38 (11.41%), and 76 (22.82%) patients underwent reintervention. A total of 70 (21.02%) patients experienced DSAE, among them were 2 patients who died of aortic rupture and 58 patients who accepted reintervention. Multivariate analysis reviewed independent risk factors of postoperative DSAE, including current smoking, the residual length of the patent false lumen, the postoperative number of dissection tears in the thoracic aorta and type III aortic arch; as well as protective factors, including the application of a restrictive bare stent (RBS), the length of covered stent in the descending thoracic aorta, and the distance from the residual first tear to the left subclavian artery (LSA). Conclusion DSAE after TEVAR for patients with a complicated TBAD can be influenced by their current smoking habit, the residual length of patent false lumen, the postoperative number of dissection tears in the thoracic aorta and the aortic arch type. Meanwhile, RBS usage, the length of the covered stent in the descending thoracic aorta and the distance from the residual first tear to the LSA could have positive effect on the prognosis.
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Affiliation(s)
- Yu Shen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Simeng Zhang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China.,Department of Congenital Heart Disease, Fuwai Hospital, National Center of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guanglang Zhu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Yanqing Chen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Zheng Chen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
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Tadros RO, Tang GH, Barnes HJ, Mousavi I, Kovacic JC, Faries P, Olin JW, Marin ML, Adams DH. Optimal Treatment of Uncomplicated Type B Aortic Dissection. J Am Coll Cardiol 2019; 74:1494-1504. [DOI: 10.1016/j.jacc.2019.07.063] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/26/2019] [Indexed: 01/16/2023]
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Midterm prognosis of type B aortic dissection with and without dissecting aneurysm of descending thoracic aorta after endovascular repair. Sci Rep 2019; 9:8870. [PMID: 31222164 PMCID: PMC6586898 DOI: 10.1038/s41598-019-45472-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 06/06/2019] [Indexed: 02/05/2023] Open
Abstract
Few studies support guidelines for the use of thoracic endovascular aortic repair (TEVAR) to address type B aortic dissection (TBAD) coexisting with descending thoracic aortic dissection and aneurysm (dTADA). This cohort study investigated midterm outcomes of TBAD with dTADA (dTADA group, n = 31) and without dTADA (non-dTADA group, n = 98) after TEVAR. Compared with the non-dTADA group, the dTADA group exhibited higher incidences of type Ia endoleak (29.0% vs. 3.1%, P < 0.001) and reintervention (16.1% vs. 5.1%, P = 0.045). The completely thrombosed rate of the thoracic false lumen was significantly lower in the dTADA group than in the non-dTADA group (45.2% vs. 80.6%, P < 0.001). Although the two groups exhibited similar mortality rates, TBAD coexisting with no regressive dTADA after TEVAR was an independent predictor of mortality (HR: 15.52, 95% CI: 1.614-149.233, P = 0.018). Moreover, the change percentages of false lumen retraction and true lumen re-expansion in the dTADA group were significantly inferior to those of the non-dTADA group at levels of 4th, 6th, 8th and 10th thoracic vertebra throughout follow-up. In conclusion, in the presence of preexisting dTADA, the failure of the dTADA to regress after TEVAR is associated with lower survival and a higher risk of reintervention.
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Ray HM, Besho JM, Au J, Charlton-Ouw KM, Estrera AL, Miller CC, Safi HJ, Azizzadeh A. The role of ascending aortic size in outcomes of patients with uncomplicated acute type B aortic dissection. J Vasc Surg 2019; 69:1011-1020. [DOI: 10.1016/j.jvs.2018.07.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 07/14/2018] [Indexed: 11/30/2022]
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Lou X, Duwayri YM, Chen EP, Jordan WD, Forcillo J, Zehner CA, Leshnower BG. Predictors of Failure of Medical Management in Uncomplicated Type B Aortic Dissection. Ann Thorac Surg 2019; 107:493-498. [PMID: 30292842 PMCID: PMC6408689 DOI: 10.1016/j.athoracsur.2018.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 05/24/2018] [Accepted: 08/13/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Optimal medical therapy (OMT) for uncomplicated type B aortic dissection (uTBAD) provides excellent short-term outcomes but is associated with a high incidence of failure. This study identified predictors of aortic intervention and mortality in uTBAD patients undergoing OMT. METHODS A retrospective review of the Emory University School of Medicine aortic database identified 314 uTBAD patients undergoing OMT from 2000 to 2016. Two hundred sixty-three (84%) patients had imaging at presentation analyzed for maximum aortic diameters (ADs), false lumen (FL) status, and visceral vessel perfusion. Cox proportional hazards models were constructed to estimate hazards ratios (HRs) and identify predictors of OMT failure. RESULTS The mean age of patients was 58 ± 12 years, and 67% were men. FL status was patent in 59.4%, partially thrombosed in 39.8%, and completely thrombosed in 0.8% of patients. Over a median follow-up of 5.6 (interquartile range, 1.4 to 8.5) years, 44.9% of patients failed OMT and underwent intervention (n = 58 open, n = 83 endovascular). The estimated incidence of OMT failure was 46%. Multivariate analysis identified the presence of diabetes, renal failure, DeBakey 3B dissection, and a descending thoracic AD of 4.5 cm or greater (HR, 1.39; 95% confidence interval, 1.24 to 1.56; p < 0.001) to be independent predictors of failure of OMT. FL status or the distribution of visceral vessels arising from the FL did not predict OMT failure. CONCLUSIONS There is a significant incidence of OMT failure in uTBAD patients. A descending thoracic AD of 4.5 cm or greater at the time of diagnosis is an independent predictor of failure of OMT.
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Affiliation(s)
- Xiaoying Lou
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Yazan M Duwayri
- Division of Vascular and Endovascular Therapy, Emory University School of Medicine, Atlanta, Georgia
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - William D Jordan
- Division of Vascular and Endovascular Therapy, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica Forcillo
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Carl A Zehner
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
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Lansman SL, Goldberg JB, Kai M, Malekan R, Spielvogel D. Extended Arch Procedures for Acute Type A Aortic Dissection: A Downstream Problem? Semin Thorac Cardiovasc Surg 2019; 31:17-20. [DOI: 10.1053/j.semtcvs.2018.07.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/24/2018] [Indexed: 11/11/2022]
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Ante M, Mylonas S, Skrypnik D, Bischoff MS, Rengier F, Brunkwall J, Böckler D. Prevalence of the Computed Tomographic Morphological DISSECT Predictors in Uncomplicated Stanford Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2018; 56:525-533. [DOI: 10.1016/j.ejvs.2018.06.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
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Shimamoto T, Komiya T, Tsuneyoshi H. Fate of uncomplicated acute type B aortic dissection and impact of concurrent aortic dilatation on remote aortic events. J Thorac Cardiovasc Surg 2018; 157:854-863. [PMID: 30201125 DOI: 10.1016/j.jtcvs.2018.05.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 04/08/2018] [Accepted: 05/13/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to describe the reliable prognostic factors of mortality and subsequent aortic events during the follow-up of uncomplicated type B acute aortic dissection. METHODS From January 2004 to December 2014, 255 patients with uncomplicated type B acute aortic dissection were admitted to our hospital. Cox proportional hazards analysis was performed to identify risk factors for all-cause mortality, aorta-related mortality, and aortic events. RESULTS In-hospital mortality was observed in 7 patients (2.7%). The rates of 5-year freedom from all-cause mortality, aorta-related mortality, and aortic events were 79.4% ± 2.9%, 93.3% ± 2.0%, and 71.7% ± 3.4%, respectively. The rate of 5-year freedom from aortic events was significantly lower among those with a patent false lumen (P = .006). Age and descending aorta diameter were independent risk factors of all-cause and aorta-related mortality (hazard ratio [HR], 1.08 and 1.13; 95% confidence interval [CI], 1.04-1.10 and 1.03-1.24; P = .0001 and .007, respectively). Independent risk factors for aortic events were descending aorta diameter, false lumen thickness, and dilatation of abdominal aorta (HR, 1.06; 95% CI, 1.02-1.12; P = .006; HR, 1.07; 95% CI, 1.04-1.11; P = .00002; HR, 2.01; CI, 1.20-3.38; P = .008). CONCLUSIONS In uncomplicated type B acute aortic dissection, the age and dilatation of the thoracic aorta were associated with a higher risk of death, whereas false lumen thickness and concurrent abdominal aortic dilatation augment the risk for aortic events.
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Affiliation(s)
- Takeshi Shimamoto
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan.
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
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Spinelli D, Benedetto F, Donato R, Piffaretti G, Marrocco-Trischitta MM, Patel HJ, Eagle KA, Trimarchi S. Current evidence in predictors of aortic growth and events in acute type B aortic dissection. J Vasc Surg 2018; 68:1925-1935.e8. [PMID: 30115384 DOI: 10.1016/j.jvs.2018.05.232] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/31/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Acute type B aortic dissection can have a stable course or evolve into aneurysm and subsequent adverse events. The aim of this systematic review was to analyze the morphologic predictors of an adverse course to establish their validity based on consistency of results. METHODS Fifty-one studies were included in this review, reporting on aortic size, false lumen (FL) size, primary entry tear (ET) size and location, status of FL thrombosis, number of ETs, branch vessels involvement, and FL longitudinal extent. RESULTS Some predictors showed good consistency, whereas others did not. Aortic size was the most investigated predictor. A larger diameter at presentation predicted worse outcomes, with few exceptions. Both FL size and size relative to true lumen size also predicted an adverse course, although a standardized measurement method was not used. Regarding primary ET size and location, evidence was sparse and somewhat conflicting. Although FL complete thrombosis was consistently associated with a more benign course, the role of partial thrombosis remained unclear and the concept of FL saccular formation might account for the inconsistency, but further evidence is needed. A higher number of re-entry tears was considered to be protective against false channel expansion, but results need to be confirmed. The predictive role of branch vessels involvement and FL longitudinal extent remain controversial. CONCLUSIONS Among several predictors of aortic growth and events in acute type B aortic dissection, controversial and even conflicting results have been described. Consistent evidence has been demonstrated only for two predictors: aortic size at presentation is associated with adverse events and total FL thrombosis has a protective role.
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Affiliation(s)
- Domenico Spinelli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy; Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Mich.
| | - Filippo Benedetto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy
| | - Rocco Donato
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Surgery and Morphological Sciences, Circolo University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | | | - Himanshu J Patel
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Mich
| | - Kim A Eagle
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Mich
| | - Santi Trimarchi
- Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Scienze Biomediche per la Salute, University of Milan, Milan, Italy
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Sato H, Ito T, Kuroda Y, Uchiyama H, Watanabe T, Yasuda N, Nakazawa J, Harada R, Kawaharada N. New predictor of aortic enlargement in uncomplicated type B aortic dissection based on elliptic Fourier analysis. Eur J Cardiothorac Surg 2018. [PMID: 28637334 DOI: 10.1093/ejcts/ezx191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to re-examine the conventional predictive factors for dissected aortic enlargement, such as the aortic and false lumen diameter and to consider whether the morphological elements of the dissected aorta could be predictors by quantifying the 'shape' of the true lumen based on elliptic Fourier analysis. METHODS A total of 80 patients with uncomplicated type B aortic dissection were included. The patients were divided into 'Enlargement group' and 'No Change group.' Between the 2 groups, the mean systolic blood pressure during follow-up, aortic and false lumen maximum diameters, and analysed morphological data were compared using each statistical method. RESULTS The maximum aortic and false lumen diameters were significantly larger in the Enlargement group than in the No Change group (39.3 vs 35.9 mm; P = 0.0058) (23.5 vs 18.2 mm; P = 0.000095). The principal component 1, which is the data calculated by elliptic Fourier analysis, was significantly lower in the Enlargement group than in the No Change group (0.020 vs - 0.072; P = 0.000049). The mean systolic blood pressure ≥130 mmHg, aortic diameter, false lumen diameter and principal component 1 were included in the Cox proportional hazard model as covariates to determine the significant predictive variable. Principal component 1 demonstrated the only significance with aortic enlargement on multivariate analysis (odds ratio = 0.32; P = 0.048). CONCLUSIONS The analysed and calculated morphological data of the shape of the true lumen can be more effective predictive factors of aortic enlargement of type B dissection than the conventional factors.
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Affiliation(s)
- Hiroshi Sato
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
| | - Toshiro Ito
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
| | - Yosuke Kuroda
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
| | - Hiroki Uchiyama
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
| | - Toshitaka Watanabe
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
| | - Naomi Yasuda
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
| | - Junji Nakazawa
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
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Tozzi P. Thoracic endovascular aortic repair to treat uncomplicated Stanford type B aortic dissection: The surgeon's dilemma to preventing future complications. Eur J Prev Cardiol 2018; 25:24-31. [PMID: 29708037 DOI: 10.1177/2047487318758100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Uncomplicated type B aortic dissections have traditionally been managed non-operatively with aggressive blood pressure control. However, the best medical treatment is associated with a considerable risk of disease progression to complicated dissection or aneurysmal degeneration of the affected aortic segment. Thoracic endovascular aortic repair could prevent long-term complications but, because the dissected aorta is vulnerable, it is a high-risk procedure performed in asymptomatic patient. Therefore, endovascular treatment is not a solution for all patients and it should be performed only in the subgroup prone to developing progression of the disease and future complications. A number of studies have suggested several prognostic factors of early or late adverse events such as the patency of the false lumen in the follow-up, an initial aortic diameter ≥4 cm with a patent false lumen, an initial false lumen diameter ≥22 mm in the proximal descending aorta, visceral involvement and recurrent or refractory pain or hypertension. Partial false lumen thrombosis and a proximal entry tear size >10 mm have also been suggested to be associated with an increased rate of aortic growth. We need randomised trials focused on these prognostic factors to reach level 1, class A recommendation for the optimal timing of intervention. Meanwhile, we have to discuss with the patient the pro and cons of this prophylactic, low-invasive but high-risk treatment to personalise medical care and provide the optimal risk-to-benefit ratio.
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Affiliation(s)
- Piergiorgio Tozzi
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Switzerland
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The incidence of delayed complications in acute type B aortic dissections is underestimated. J Vasc Surg 2018; 68:356-363. [PMID: 29615351 DOI: 10.1016/j.jvs.2017.11.089] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/13/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Acute type B aortic dissections (TBADs) can have immediate or delayed complications within the first 2 weeks. Because the majority of clinical series retrospectively categorized TBAD, the incidence and outcome of delayed complications in initially uncomplicated TBAD within the first 14 days are not well described. METHODS We retrospectively analyzed 86 patients (78% male; age, 62.5 ± 13 years) with acute TBAD treated consecutively between January 2004 and May 2016 at a tertiary referral center. All TBADs were confirmed by computed tomography angiography (CTA) on admission, after 2 to 5 days, and after 10 to 14 days. Study end points were the incidence of immediate and delayed complications (aortic rupture, malperfusion, rapid aortic expansion >4 mm, pain or hypertension resistant to medical therapy) and in-hospital mortality. In addition, we looked at CTA-detected morphometric variables (maximum diameters of descending aorta, false lumen [FL], and primary entry tear; number of intimal tears; FL configuration; true lumen collapse; course of the dissection) and their association with delayed complications. Finally, we assessed treatment modalities and clinical outcomes. RESULTS Of all TBADs, 22 (26%) presented with immediate complications (rupture, n = 11); 64 patients (74%) were initially assessed as having uncomplicated TBAD. Of these 64 patients, 24 (28% of all 86) suffered from delayed complications (malperfusion, n = 10; aortic rupture, n = 3; early expansion >4 mm, n = 8; refractory pain, n = 2; uncontrollable hypertension, n = 1) at a median interval of 7.1 (2-14) days after symptom onset. During the first 14 days, 40 patients (46%) remained uncomplicated. The CTA analysis revealed a significant association of initial thoracic aortic diameter (P = .009), size of the primary entry tear (P = .018), true lumen collapse (P = .019), and partially thrombosed FL (P = .019) with the occurrence of delayed complications within the first 14 days. Of the patients with delayed complications, 87.5% underwent surgery (90% thoracic endovascular aortic repair, 10% peripheral revascularization); 12.5% in this group died following aortic rupture before they received surgical repair. The mortality of patients with delayed complicated TBAD was significantly higher compared with those who remained uncomplicated within the 14-day period (12.5% vs 0%; P = .0221). CONCLUSIONS Delayed complications in initially uncomplicated acute TBAD are not infrequent. Morphologic variables like maximum diameter of the descending aorta, primary entry tear, true lumen collapse, and partially thrombosed FL were associated with an increased risk of delayed complications in initially uncomplicated TBAD. Future clinical research must verify the predictive role of clinical and morphologic variables in the acute phase, particularly with regard to a possible early surgical treatment to prevent a fatal outcome.
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Yuan X, Mitsis A, Ghonem M, Iakovakis I, Nienaber CA. Conservative management versus endovascular or open surgery in the spectrum of type B aortic dissection. J Vis Surg 2018; 4:59. [PMID: 29682469 DOI: 10.21037/jovs.2018.02.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/09/2018] [Indexed: 01/16/2023]
Abstract
Background Type B aortic dissection is a life-threatening acute aortic condition often with acute ischemic signs or symptoms. With initial management focusing on alleviating malperfusion and pain, and avoiding propagation of dissection or rupture both systolic blood and pulse pressure should be reduced initially by an aggressive medical approach. In the setting of persistent signs of complications endovascular strategies have replaced open surgery and led to a fourfold increase in early survival and better long-term outcomes. Methods An electronic health database search was performed on articles published between January 2006 and July 2017. Publications were included in this review if (I) the index aortic pathology was type B aortic (distal) dissection; (II) when medical management, open surgical replacement or thoracic endovascular aortic repair were among those options; (III) when at least one of all basic outcome criteria such as survival, spinal cord ischemia and cerebrovascular accident was reported; (IV) when ≥15 serial patients were included. A total of 62 studies were eligible and analysed. Results Our manuscript has summarized data collected over 12 years on management specific outcomes in the setting of distal aortic dissection and provides an up-to-date interpretation of the published evidence. For complicated cases, treated acutely, the 30-day or in-hospital mortality was 7.3% when managed by endovascular means, whereas the pooled rate for 30-day or in-hospital mortality was 19.0% when subjected to open repair. For acute uncomplicated type B dissection usually treated with blood pressure lowering medications, the pooled 30-day or in-hospital mortality rate was 2.4%. Survival rates at 5 years averaged at 60% (40% mortality). Freedom from any aortic event ranged from 34.0% to 83.9%, underlining an inherent risk of progression and late complications. For chronic complicated type B dissection, the rates of stroke, paraplegia and operative mortality following endovascular repair ranged from 5% to 13%, 2% to 13% and 2 to 13%, respectively, while 5-year survival rates after open repair ranged from 60% to 90%. In chronic uncomplicated type B dissection almost 90% of patients survive initial hospitalization and were subjected to medical management with a 5-year survival of 50-80%. However, up to 20-55% of medically treated patients develop aneurysmal degeneration after 5 years with an unknown risk of rupture. Conclusions Currently, the less invasive strategy of endovascular repair (as compared to open surgery) provides improved 30-day or in-hospital survival in the setting of complicated acute type B aortic dissection and may seek broad application. Open surgical aortic reconstruction should be left to experienced aortic centres if endovascular management is not an option.
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Affiliation(s)
- Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Andreas Mitsis
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Mohammed Ghonem
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Ilias Iakovakis
- Cardiac Surgery Department, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
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Schwartz SI, Durham C, Clouse WD, Patel VI, Lancaster RT, Cambria RP, Conrad MF. Predictors of late aortic intervention in patients with medically treated type B aortic dissection. J Vasc Surg 2018; 67:78-84. [DOI: 10.1016/j.jvs.2017.05.128] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 05/24/2017] [Indexed: 10/18/2022]
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Abstract
Stanford type B aortic dissection (TBAD) is a life-threatening disease. Current therapeutic guidelines recommend medical therapy with aggressive blood pressure lowering for patients with acute TBAD unless they have fatal complications. Although patients with uncomplicated TBAD have relatively low early mortality, aorta-related adverse events during the chronic phase worsen the long-term clinical outcome. Recent advances in thoracic endovascular aortic repair (TEVAR) can improve clinical outcomes in patients with both complicated and uncomplicated TBAD. According to present guidelines, complicated TBAD patients are recommended for TEVAR. However, the indication in uncomplicated TBAD remains controversial. Recent results of randomized trials, which compared the clinical outcome in patients treated with optimal medical therapy and those treated with TEVAR, suggest that preemptive TEVAR should be considered in uncomplicated TBAD with suitable aortic anatomy. However, these trials failed to show improvement in early mortality in patients treated with TEVAR compared with patients treated with optimal medical therapy, which suggest the importance of patient selection for TEVAR. Several clinical and imaging-related risk factors have been shown to be associated with early disease progression. Preemptive TEVAR might be beneficial and should be considered for high-risk patients with uncomplicated TBAD. However, an interdisciplinary consensus has not been established for the definition of patients at high-risk of TBAD, and it should be confirmed by experts including physicians, radiologists, interventionalists, and vascular surgeons. This review summarizes the current understanding of the therapeutic strategy in patients with TBAD based on evidence and expert consensus.
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Affiliation(s)
- Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
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Matsushita A, Hattori T, Tsunoda Y, Sato Y, Mihara W. Impact of initial aortic diameter and false-lumen area ratio on Type B aortic dissection prognosis†. Interact Cardiovasc Thorac Surg 2017; 26:176-182. [DOI: 10.1093/icvts/ivx286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 08/03/2017] [Indexed: 01/16/2023] Open
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Kamman AV, Jonker FH, Sechtem U, Harris KM, Evangelista A, Montgomery DG, Patel HJ, Eagle KA, Trimarchi S. Predictors of Stable Aortic Dimensions in Medically Managed Acute Aortic Syndromes. Ann Vasc Surg 2017; 42:143-149. [DOI: 10.1016/j.avsg.2017.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/27/2016] [Accepted: 01/23/2017] [Indexed: 01/16/2023]
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Abstract
Stanford type B aortic dissections (TBADs) involve the descending aorta and can present with complications, including malperfusion syndrome or aortic rupture, which are associated with significant morbidity and mortality if left untreated. Clinical diagnosis is straightforward, typically confirmed using CT angiography. Treatment begins with immediate anti-impulse medical therapy. Acute TBAD with complications should be repaired with emergent thoracic endovascular aortic repair (TEVAR). Uncomplicated TBAD with high-risk features should undergo TEVAR in the subacute phase. Open surgical repair is seldom required and reserved only for select cases. It is critical to follow these patients clinically and radiographically in the outpatient setting.
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Affiliation(s)
- Daniel B Alfson
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, 1520 San Pablo Street, HCC II, Suite 4300, Los Angeles, CA 90033-5330, USA
| | - Sung W Ham
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, 1520 San Pablo Street, HCC II, Suite 4300, Los Angeles, CA 90033-5330, USA.
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Sailer AM, van Kuijk SMJ, Nelemans PJ, Chin AS, Kino A, Huininga M, Schmidt J, Mistelbauer G, Bäumler K, Chiu P, Fischbein MP, Dake MD, Miller DC, Schurink GWH, Fleischmann D. Computed Tomography Imaging Features in Acute Uncomplicated Stanford Type-B Aortic Dissection Predict Late Adverse Events. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005709. [PMID: 28360261 DOI: 10.1161/circimaging.116.005709] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 02/16/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Medical treatment of initially uncomplicated acute Stanford type-B aortic dissection is associated with a high rate of late adverse events. Identification of individuals who potentially benefit from preventive endografting is highly desirable. METHODS AND RESULTS The association of computed tomography imaging features with late adverse events was retrospectively assessed in 83 patients with acute uncomplicated Stanford type-B aortic dissection, followed over a median of 850 (interquartile range 247-1824) days. Adverse events were defined as fatal or nonfatal aortic rupture, rapid aortic growth (>10 mm/y), aneurysm formation (≥6 cm), organ or limb ischemia, or new uncontrollable hypertension or pain. Five significant predictors were identified using multivariable Cox regression analysis: connective tissue disease (hazard ratio [HR] 2.94, 95% confidence interval [CI]: 1.29-6.72; P=0.01), circumferential extent of false lumen in angular degrees (HR 1.03 per degree, 95% CI: 1.01-1.04, P=0.003), maximum aortic diameter (HR 1.10 per mm, 95% CI: 1.02-1.18, P=0.015), false lumen outflow (HR 0.999 per mL/min, 95% CI: 0.998-1.000; P=0.055), and number of intercostal arteries (HR 0.89 per n, 95% CI: 0.80-0.98; P=0.024). A prediction model was constructed to calculate patient specific risk at 1, 2, and 5 years and to stratify patients into high-, intermediate-, and low-risk groups. The model was internally validated by bootstrapping and showed good discriminatory ability with an optimism-corrected C statistic of 70.1%. CONCLUSIONS Computed tomography imaging-based morphological features combined into a prediction model may be able to identify patients at high risk for late adverse events after an initially uncomplicated type-B aortic dissection.
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Affiliation(s)
- Anna M Sailer
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Sander M J van Kuijk
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Patricia J Nelemans
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Anne S Chin
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Aya Kino
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Mark Huininga
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Johanna Schmidt
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Gabriel Mistelbauer
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Kathrin Bäumler
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Peter Chiu
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Michael P Fischbein
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Michael D Dake
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - D Craig Miller
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Geert Willem H Schurink
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.)
| | - Dominik Fleischmann
- From the Department of Radiology (A.M.S., A.S.C., A.K., K.B., D.F.), Department of Cardiothoracic Surgery (P.C., M.P.F., M.D.D., D.C.M.), and the Stanford Cardiovascular Institute (M.D.D., D.F.), Stanford University School of Medicine, CA; Department of Radiology (A.M.S.), Department of Clinical Epidemiology and Medical Technology Assessment (S.M.J.v.K.), Department of Epidemiology (P.J.N.), and Department of Vascular Surgery (M.H., G.W.H.S.), Maastricht University Medical Center, The Netherlands; Institute of Simulation and Graphics, Otto von Guericke University Magdeburg, Germany (G.M.); and the Institute for Computer Graphics, Vienna University of Technology, Austria (J.S., G.M.).
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Kamman AV, Brunkwall J, Verhoeven EL, Heijmen RH, Trimarchi S, Kasprzak P, Brunkwall J, Heijmen R, Alric P, Verhoeven E, Schumacher H, Fabiani JN, Eckstein HH, Taylor P, Mailina M, Mangialardi N, Larzon T, Böckler D, Lönn L, Dialetto G, Trimarchi S, Lammer J. Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database. J Vasc Surg 2017; 65:964-971.e3. [DOI: 10.1016/j.jvs.2016.09.033] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/01/2016] [Indexed: 01/16/2023]
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Song C, Lu Q, Zhou J, Yu G, Feng X, Zhao Z, Bao J, Feng R, Jing Z. The new indication of TEVAR for uncomplicated type B aortic dissection. Medicine (Baltimore) 2016; 95:e3919. [PMID: 27336881 PMCID: PMC4998319 DOI: 10.1097/md.0000000000003919] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The classical therapeutic indication for type B aortic dissection is based on either medication or open surgery; medication therapy is recommended for relatively stable uncomplicated type B aortic dissection. With improvements in endovascular repair and the potential risk of disease progression, it is now necessary to evaluate the requirement for revision of the therapeutic choice of uncomplicated type B aortic dissection based on morphological features and time window. Data from 252 patients diagnosed as uncomplicated type B aortic dissection from 1992 to 2015 were analyzed retrospectively. Among these cases, 117 patients received medication therapy and 135 patients underwent endovascular repair. The 60-month survival rate in the endovascular group was higher than that in the medication group (92.3% vs 67.6%). According to the morphological evaluation, visceral artery involvement and false/true lumen ratios over 0.7 were strong risk factors for medical treatment alone. Increased surgical time and blood loss were found in patients treated in the chronic phase, compared with those who underwent endovascular repair within 14 days of the onset of symptoms. With improvements in aortic remodeling techniques, endovascular repair has been shown to improve long-term survival rates of patients with uncomplicated aortic dissection. Considering the potential risk of death, we recommend that patients with visceral artery involvement and a false/true lumen ratio over 0.7 should receive endovascular repair aggressively. Furthermore, delayed endovascular repair in the chronic phase does not improve the long-term outcome of uncomplicated type B aortic dissection.
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Yu SCH, Liu W, Wong RHL, Underwood M, Wang D. The Potential of Computational Fluid Dynamics Simulation on Serial Monitoring of Hemodynamic Change in Type B Aortic Dissection. Cardiovasc Intervent Radiol 2016; 39:1090-8. [PMID: 27169665 DOI: 10.1007/s00270-016-1352-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to assess the potential of computational fluid dynamics simulation (CFD) in detecting changes in pressure and flow velocity in response to morphological changes in type B aortic dissection. MATERIALS AND METHODS Pressure and velocity in four morphological models of type B aortic dissection before and after closure of the entry tear were calculated with CFD and analyzed for changes among the different scenarios. The control model (Model 1) was patient specific and built from the DICOM data of CTA, which bore one entry tear and three re-entry tears. Models 2-4 were modifications of Model 1, with two re-entry tears less in Model 2, one re-entry tear more in Model 3, and a larger entry tear in Model 4. RESULTS The pressure and velocity pertaining to each of the morphological models were unique. Changes in pressure and velocity findings were accountable by the changes in morphological features of the different models. There was no blood flow in the false lumen across the entry tear after its closure, the blood flow direction across the re-entry tears was reversed after closure of the entry tear. CONCLUSION CFD simulation is probably useful to detect hemodynamic changes in the true and false lumens of type B aortic dissection in response to morphological changes, it may potentially be developed into a non-invasive and patient-specific tool for serial monitoring of hemodynamic changes of type B aortic dissection before and after treatment.
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Affiliation(s)
- Simon C H Yu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Wen Liu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
| | - Randolph H L Wong
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
| | - Malcolm Underwood
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, c/o Rm 2A061, 2/F, Main Clinical Block and Trauma Centre, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
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