Morphologic Characteristics for Treatment Guidance in Uncomplicated Acute Type B Aortic Dissection

Abstract

The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl

Volumetric analysis of the initial index computed tomography scan can predict the natural history of acute uncomplicated type B dissections

“…The emerging field of volumetric data analysis has been more commonly applied to follow up patients who underwent TEVAR and to assess for aortic remodeling after endovascular aortic repair. 17 It has been shown that intraobserver and interobserver testing for CT-guided volume measurements has a reproducibility coefficient of 5% to 10% and that volumetric measurements can be superior to simple diameter measurement during follow-up of patients treated with TEVAR. 3 However, volumetric measurements are time-consuming and require expensive software and therefore are difficult to apply routinely in clinical practice.…”

The new indication of TEVAR for uncomplicated type B aortic dissection

“…Increased diameter of the patent false lumen has been demonstrated to be a significant independent predictor of dissection rupture and aneurysmal degeneration, with the growth rate of the chronically dissected aorta estimated to range from 0.1 to 0.74 cm per year depending on both the initial aortic diameter and the state of hypertension. [11–17] Rudenick et al [18] demonstrated the influence of tear configuration on the false and true lumen hemodynamics in the presence of an adequate outflow at the distal part of the dissection flap, thus, validating distal outflow as a risk factor of progressive dilation. Although lowering outflow with decreased blood pressure may be valuable in such patients, aneurysmal dilatation of the aorta is confirmed at follow-up in more than 20% of medically managed patients, which is consistent with our observation (29%).…”