Impact of New Development of Ulcer-Like Projection on Clinical Outcomes in Patients With Type B Aortic Dissection With Closed and Thrombosed False Lumen

Kitai, Takeshi; Kaji, Shuichiro; Yamamuro, Atsushi; Tani, Tohru; Kinoshita, Makoto; Ehara, Natsuhiko; Kobori, Atsushi; Kita, Toru; Furukawa, Yutaka

doi:10.1161/circulationaha.109.927517

Cited by 99 publications

(84 citation statements)

References 23 publications

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“…ULP have been reported in 33-36% of patients with type B AAD. 35, 36 Data collected for the present study, however, did not include whether patients with non-communicating false lumens had ULP. We were therefore unable to determine how many patients with non-communicating false lumens had ULP on CT. Second, large (>10 mm) long-axis-direction pouches of contrast medium in the non-communicating false lumen (Figure 2C), which should be classified as belonging to the C group, may mistakenly have been classified as ULP with a noncommunicating false lumen (Figure 2B) in the NC group.…”

Section: Prevalence Of Non-communicating False Lumen and Imh In Aadmentioning

confidence: 98%

Acute Type B Aortic Dissection With Communicating vs. Non-Communicating False Lumen

Akutsu

Yoshino²,

Tobaru³

et al. 2015

Circ J

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Background:In practice, patients with acute aortic dissection (AAD) are generally divided into 2 groups according to the status of the false lumen: non-communicating or communicating. The similarities and differences between the 2 groups, however, have not been fully determined in a large population. Methods and Results:We studied 502 patients with Stanford type B AAD. Clinical background at symptom onset was compared, and similarities and differences characterized, for patients with non-communicating (NC group, n=288) vs. communicating (C group, n=214) false lumens. Time of day (00.00-06.00 hours, 06.00-12.00 hours, 12.00-18.00 hours, and 18.00-24.00 hours) and extent of physical activity (extreme exertion, slight exertion, at rest, and sleeping) at symptom onset were similar between groups. Patients in the NC group were older (mean age, 71±11 years vs. 64±14 years, P<0.01) and had lower prevalence of distally extended aortic dissection (26% vs. 8%, P<0.01) and deaths in hospital (2% vs. 7%, P=0.011) than those in the C group. Conclusions:At symptom onset, clinical circumstances and physical activity were similar between the groups, and old age and a background of DeBakey IIIa aortic dissection may be associated with determination of false lumen status. The outcome in the NC group was better than in the C group. (Circ J 2015; 79: 567 -573)

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Section: Prevalence Of Non-communicating False Lumen and Imh In Aadmentioning

confidence: 98%

Acute Type B Aortic Dissection With Communicating vs. Non-Communicating False Lumen

Akutsu

Yoshino²,

Tobaru³

et al. 2015

Circ J

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“…1 The following signs have been associated with poor outcome and more rapid disease progression than baseline: patency of the presence of flow but absence of thrombus (FL) during follow-up, increased number of entry tears, initial aortic diameter ⩾4 cm with a patent FL, initial FL diameter ⩾22 mm in the proximal descending aorta, visceral vessel involvement and recurrent or refractory pain or hypertension. 7,37,[122][123][124][125][126] Connective tissue disorders. TEVAR has been reported to be feasible for Marfan patients (although this is controversial); 127 however, reintervention rates are high as Marfandiseased aortas tend to dilate over time after TEVAR.…”

Section: Chronic Treatmentmentioning

confidence: 99%

Update in the management of type B aortic dissection

et al. 2016

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Stanford type B aortic dissection (TBAD) is a life-threatening aortic disease. The initial management goal is to prevent aortic rupture, propagation of the dissection, and symptoms by reducing the heart rate and blood pressure. Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up. Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion. Recent developments in diagnosis and management have reduced mortality related to TBAD considerably. In particular, the introduction of thoracic stent-grafts has shifted the management from surgical to endovascular repair, contributing to a fourfold increase in early survival in complicated TBAD. Furthermore, endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy. For more challenging aortic dissection patients with involvement of the aortic arch, hybrid approaches, combining open and endovascular repair, have had promising results. Regardless of the chosen management strategy, strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance. Future developments in stent-graft design, medical therapy, surgical and hybrid techniques, imaging, and genetic screening may improve the outcomes of TBAD patients even further. We present a comprehensive review of the recommended management strategy based on current evidence in the literature.

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“…The survival rate of the patients who developed ULPs was higher than that of the patients who did not develop ULPs [14]. The presence or absence of ULP was a significant difference in the incidence of complications [20].…”

Section: Ulcer-like Projection In Aortic Dissectionmentioning

confidence: 86%

“…A total of 170 patients admitted with acute Type B of the complete thrombosis type, 62 (36%) of these patients showed new ULP development [14]. Moreover, Kitai et al retrospectively analyzed 38 consecutive patients who had a complete thrombosis type without an ULP.…”

Section: Ulcer-like Projection In Aortic Dissectionmentioning

confidence: 99%

“…For the complete thrombosis type, presence or absence of an ULP becomes a diagnostic standard. A sample CT image with an ULP reportedly has a bad prognosis [14,16,21]. In such cases involving an ULP, the time-dependent changes in ULPs have been discussed, which involve expansion, invariability, reduction, and disappearance [22].…”

Section: Ulcer-like Projection In Aortic Dissectionmentioning

confidence: 99%

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Numerical Simulation in Ulcer-Like Projection due to Type B Aortic Dissection with Complete Thrombosis Type

Mori¹,

Ohtake²,

Watanabe³

et al. 2013

Aortic Aneurysm - Recent Advances

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Impact of New Development of Ulcer-Like Projection on Clinical Outcomes in Patients With Type B Aortic Dissection With Closed and Thrombosed False Lumen

Abstract: Initial aortic diameter and development of ULP in the PD are both strong predictors of adverse aorta-related events in patients with type B AD with CTFL. Patients with newly developed ULP should be more carefully followed up with close surveillance imaging than those without ULP.

Cited by 99 publications

References 23 publications

Acute Type B Aortic Dissection With Communicating vs. Non-Communicating False Lumen

Acute Type B Aortic Dissection With Communicating vs. Non-Communicating False Lumen

Update in the management of type B aortic dissection

Numerical Simulation in Ulcer-Like Projection due to Type B Aortic Dissection with Complete Thrombosis Type

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