Long-term follow-up of acute type B aortic dissection: Ulcer-like projections in thrombosed false lumen play a role in late aortic events

Abstract

In type B aortic dissection, a thrombosed false lumen with ulcer-like projections and a patent false lumen had an influence on late aortic dilation and late aortic events.

False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

“…Subgroup analysis showed that the pooled HR for long‐term mortality with postoperative residual patent false lumen was 2.02 (95% CI, 1.13–3.61; P =0.017) with no significant heterogeneity (I 2 =29.6%; P =0.233). For studies in the type B category,18, 19, 28 the pooled HR for long‐term mortality with preoperative residual patent false lumen was 2.79 (95% CI, 1.80–4.32; P <0.001; Figure 2); no statistically significant heterogeneity was observed (I 2 =0.0%; P =0.386). Because of the small number of studies, sensitivity analysis and Egger's test were not performed.…”

“…Four studies17, 22, 26, 27 examined the association between the false lumen status and AAD outcomes in type A patients, and another 6 studies18, 19, 20, 28, 29, 30 examined associations in type B patients. One study21 included both type A (73%) and type B (27%) AAD; in subgroup analysis based on the Stanford classification, this study was placed in the type A group.…”

“…Three studies17, 18, 28 reported that a residual patent false lumen was significantly associated with an increased risk of long‐term aortic events (n=832; HR, 5.43; 95% CI, 2.95–9.99; P <0.001) without significant heterogeneity (I 2 =0.0%; P =0.566). One study reported an HR for long‐term aortic events with residual patent false lumen in AAD type A cases of 4.11 (95% CI, 1.85–9.16; P =0.001), and 2 studies reported that a residual patent false lumen was a predictor of aortic events in type B cases (HR, 7.97; 95% CI, 3.11–20.41; P <0.001) with no significant heterogeneity (I 2 =0.0%; P =0.852).…”

“…A large prospective cohort study indicated that preoperative false lumen patency influenced outcomes over a 6.8‐year follow‐up in AAD type A, with decreased survival rates (HR, 1.70; P =0.012) and an increase in the number of distal aortic events (HR, 4.11; P =0.001), controlling for conventional risk factors 17. Another 3 small sample‐size observational studies showed an independent association between the presence of a patent false lumen and long‐term mortality and aortic events in AAD type B 18, 19, 28. However, 1 retrospective cohort study indicated that postoperative false lumen patency was independently related to 5‐year mortality for type A cases, whereas preoperative false lumen patency was not a predictor of mortality 21.…”

Aneurysmal degeneration of the thoracoabdominal aorta after medical management of type B aortic dissections

“…21 However these studies have shown that aortic diameter >40 mm correlates with aortic growth. 10,19,[22][23][24][25][26][27] The current study shows that an aortic diameter >35 mm is a risk factor for subsequent aortic dilation. In future trials of TEVAR for acute type B dissection, this lower threshold should be considered.…”