Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database

Kamman, Arnoud V.; Kasprzak, Piotr; Brunkwall, Jan; Heijmen, Robin H.; Alric, Pierre; Verhoeven, Eric L.G.; Schumacher, H.; Fabiani, Jean Noël; Eckstein, Hans‐Henning; Taylor, Peter R.; Mailina, Martin; Mangialardi, Nicola; Larzon, Thomas; Böckler, Dittmar; Lönn, Lars; Dialetto, Giovanni; Trimarchi, Santi; Lämmer, Johannes

doi:10.1016/j.jvs.2016.09.033

Cited by 98 publications

(71 citation statements)

References 31 publications

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“…Kamman et al reported that the number of vessels originating from the false lumen is an independent risk factor of false lumen growth in patients with type B aortic dissection. 21) On the other hand, no significant differences in freedom from aorta-related death and freedom from distal aortic reoperation were observed between the groups although the percentage of the patients with postoperative patent false lumen at the descending aorta was significantly higher in the young group. Therefore, our aggressive approach of extended aortic arch replacement at the time of the initial operation is acceptable.…”

Section: Discussionmentioning

confidence: 75%

Characteristics and Surgical Results of Acute Type A Aortic Dissection in Patients Younger Than 50 Years of Age

Tamura

Chikazawa

Hiraoka

et al. 2019

Annals of Vascular Diseases

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The aim of this study is to investigate the characteristics and surgical outcomes of acute type A aortic dissection (AAAD) in patients younger than 50 years of age. Methods: We retrospectively evaluated 307 patients who consecutively underwent surgical treatment for AAAD in our institute from January 2007 to June 2017. Patients were classified into two groups: the young group with 31 patients aged younger than 50 and the old group with 276 patients aged 50 years or older. Results: In-hospital mortality was similar in both groups (3.2% vs. 9.4%, p=0.19). Overall survival at 5 years was higher in the young group than that in the old group (97% vs. 71%, p=0.017). No significant differences were observed in freedom from aorta-related death and distal aortic reoperation at 5 years (97% vs. 87%, p=0.26; 86% vs. 92%, p=0.093). The percentage of young patients with postoperative patent false lumen at the descending aorta was significantly higher than that of old patients (76% vs. 30%, p<0.001) in spite of primary entry resection. Conclusion: Early and mid-term outcomes for AAAD in young patients were satisfactory. However, future follow-up is important because postoperative patent false lumen is at a high rate in young patients in spite of entry resection.

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Section: Discussionmentioning

confidence: 75%

Characteristics and Surgical Results of Acute Type A Aortic Dissection in Patients Younger Than 50 Years of Age

Tamura

Chikazawa

Hiraoka

et al. 2019

Annals of Vascular Diseases

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“…However, in the previously reported studies providing predicting factors for adverse aortic remodeling and aneurysmal formation, the reproducibility of various morphologic assessments was not assessed. 4,5,[18][19][20][21][22][23][24][25][26][27][28][29] In the present study, we aimed to provide a comparison of the reproducibility of two-and three-dimensional morphologic measurement techniques.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Introduction To identify patients with aneurysmal degeneration of the native aorta following type A aortic dissection (TAAD), reproducible serial measurements of aortic dimensions are critical. We used a systematic workflow for measuring aortic geometry following TAAD, using computed tomography angiography data, and test its reproducibility. Methods The workflow for aortic measurements included centerline generation, luminal diameter, and area measurement at six anatomically defined locations along the aorta and luminal volumetric measurements in the descending aorta. Two independent observers measured the aortic geometry in 20 surgically repaired TAAD patients, preoperatively and at 3 months follow‐up. To test reproducibility, intraobserver and interobserver agreement scores were analyzed using a concordance correlation coefficient (CCC). Results The interobserver agreement scores of the diameter, area, and volumetric measurements in the descending aorta were acceptable. The agreement scores of the area measurements were highest, with CCCs ranging from 0.909 to 0.984. Luminal diameter measurements scored lower than luminal area measurements and were least reproducible at the mid aortic arch (CCC < 0.886). Overall, intraobserver agreement scores were better than interobserver agreement scores (SD of mean difference was 1.89 vs 1.94 for intraobserver vs interobserver diameter measurements, and 0.61 vs 0.66 for area measurements). Conclusion Although overall reproducibility was acceptable in descending aortic measurements, our results show that it remains challenging to reliably measure luminal diameters, compared with areas. To aid identification of early adverse remodeling following acute TAAD, novel two‐ and three‐dimensional measurement techniques are needed that capture locoregional changes in the false lumen and true lumen morphology more accurately.

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“…These risk factors are indications for surgical intervention. Recently reported predictive factors of aortic enlargement include the number of vessels originating from the false lumen [17] and the number of intercostal arteries [18]. However, the mechanism of aortic expansion in chronic aortic dissection remains unclear.…”

Section: Discussionmentioning

confidence: 99%

The Impact of the Morphologic Characteristics of Type B Aortic Dissection in the Acute Phase on the Aortic Enlargement in the Late Stage

Nakamura¹,

Uchida²,

Hamasaki³

et al. 2019

WJCD

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Objectives: According to the International Registry of Acute Aortic Dissection, >70% of patients with type-B aortic dissection (AD) have delayed aortic growth. The objective of this study was to investigate the morphologic characteristics of aortic enlargement in type-B AD. Methods: A total of 120 patients with uncomplicated acute type-B aortic dissection (uATBAD) were divided into 4 groups according to the presence of a patent or thrombosed false lumen (FL) with or without aortic enlargement. In all groups, the area of the true lumen (TL) and the FL were measured on axial computed tomography images. Results: A total of 120 uATBAD patients were evaluated: patent FL with (PE, N = 28, 23%) or without aortic enlargement (PU, N = 17, 14%) and thrombosed FL with (TE, N = 34, 28%) or without enlargement (TU, N = 41, 34%). The initial aortic diameter was not significantly different among the 4 groups (PE vs. PU = 39 ± 8 vs. 37 ± 10 (p = 0.354); TE vs. TU = 38 ± 6 vs. 37 ± 6 (p = 0.391)). The area of the FL tended to be larger in the PE group. In contrast, the area of the TL was significantly larger in the TE group. Late outcomes of uATBAD treated with optimal medical treatment were acceptable. Conclusions: In patients with uATBAD and a thrombosed FL, the patients with aortic enlargement tended to be increased TL size. In contrast, in patients with a patent FL, the patients with aortic enlargement tended to be increased FL size.

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Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database

Cited by 98 publications

References 31 publications

Characteristics and Surgical Results of Acute Type A Aortic Dissection in Patients Younger Than 50 Years of Age

Characteristics and Surgical Results of Acute Type A Aortic Dissection in Patients Younger Than 50 Years of Age

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

The Impact of the Morphologic Characteristics of Type B Aortic Dissection in the Acute Phase on the Aortic Enlargement in the Late Stage

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