A novel anatomic severity grading score for acute Type B aortic dissections and correlation to aortic reinterventions after thoracic endovascular aortic repair

Abstract

BackgroundWe introduce a novel preoperative anatomic severity grading system for acute type B aortic dissections and validate the system in a cohort of patients who underwent thoracic endovascular aortic repair.MethodsWe identified a cohort of patients who received thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection from 2008 to 2014. We developed an anatomic severity grading score (ASG) to measure attributes of aortic anatomy that we hypothesized may affect difficulty or durability of repair. Measurements were made using computed tomography angiography images and based on hypothesized severity, giving a potential score range of 0-38.ResultsWe analyzed the computed tomography angiography images on a cohort of 30 patients with acute type B aortic dissection who underwent TEVAR. We created an area under the receiver operating characteristic curve (AUROC) using anatomic severity grading to predict aortic-related reinterventions. The AUROC was 0.72 (95% CI 0.39 to 1.1). Guided by the AUROC, we divided patients into two groups: a low-score group with anatomic severity grading scores <23 (n = 22), and a high-score group with scores ≥23 (n = 8). With this cutoff, anatomic severity grading exhibited 80% sensitivity and 84% specificity in predicting aortic-related reinterventions, with reinterventions in 50% of high-score patients and 4.5% of low-score patients (P = 0.011). The high score group also had significantly greater blood loss (200 vs 100 mL, P = 0.038), fluoroscopy time (36.0 vs 16.6 min; P = 0.022), and a trend for increased procedure time (164 vs 95 min; P = 0.083) than the low-risk group. Kaplan-Meier analysis revealed that the high-score group had a significantly decreased freedom from aortic-related reinterventions than the low-score group (38% vs 100% at 12-month followup; log rank P = 0.001).ConclusionsA preoperative anatomic severity grading score for acute type B aortic dissections consists of analysis of the proximal landing zone, curvature and tortuosity of the aorta, dissection anatomy, aortic branch vessel anatomy, and supraceliac aorta anatomy. Anatomic severity grading scores ≤23 are an excellent predictor of aortic-related reinterventions.

Image Predictors of Treatment Outcome after Thoracic Aortic Dissection Repair

“…On the proximal side, the location of the primary intimal tear and the tortuosity of the arch are the most important factors. Therefore, detailed preprocedural imaging is required to analyze the aortic diameters, arch branching variation, the curvature and tortuosity of the aorta, the presence of stenosis, the burden of calcification and/or thrombus, prior bypass surgeries, and the location and extent of the primary intimal tear (40).…”

“…In type II variation, the distance is between one and two diameters of the left common carotid artery. In type III variation, the distance is more than two diameters of the left common carotid artery (40). Type II and type III aortic arches have been shown to have a reduced TEVAR-native aorta contact surface, with resulting higher rates of endoleak and stroke, compared with the rates in type I.…”

Erratum to: A novel anatomic severity grading score for acute Type B aortic dissections and correlation to aortic reinterventions after thoracic endovascular aortic repair

“…The original article [ 1 ] contained an error in the Abstract whereby the symbol ‘≤’ was incorrectly used in the following sentence:…”

Critical appraisal of multidimensional CT measurements following acute open repair of type A aortic dissection

“…Additionally, luminal area and volumetric measurements can be obtained from computed tomography angiography (CTA) image data. In recent years, various measurement techniques have been used to define endpoints in studies analyzing the effectiveness of different techniques for aortic repair 10–13 . However, these studies all use a different approach for measuring aortic morphology, and the interobserver and intraobserver agreement scores are not reported, making their reproducibility questionable.…”