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

Lavingia, Kedar S.; Larion, Sebastian; Ahanchi, Sadaf S.; Ammar, Chad P.; Bhasin, Mohit; Mirza, Aleem K.; Dexter, David J.; Panneton, Jean M.

doi:10.1016/j.jvs.2015.04.449

Cited by 16 publications

(11 citation statements)

References 23 publications

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“…This measurement allows this reader to overcome the limitation of intimal flap mobility during the cardiac cycle (Fig 4). A more comprehensive approach to measure FL size was used by Lavingia et al, 48 who found the FL volume and TLV/FLV ratio to predict delayed aortic intervention. These investigators established two cutoff values for this ratio, at less than 0.8 (highly predictive for need of aortic intervention) and at greater than 1.6 (highly predictive for freedom from intervention) and performed a subgroup analysis that showed a significantly a different growth rate among the three groups.…”

Section: Resultsmentioning

confidence: 99%

“…52 The measurement of aortic volumes is a promising and reproducible technique, but it is still time consuming and not routinely performed. 48 Conversely, the reproducibility of the measurement of number and size of ET has been questioned (Fig 6). 56 In addition, bias might be present for detecting the location of the proximal ET at the level of the arch.…”

Section: Discussionmentioning

confidence: 99%

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Current evidence in predictors of aortic growth and events in acute type B aortic dissection

Spinelli

Benedetto

Donato

et al. 2018

Journal of Vascular Surgery

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Current evidence in predictors of aortic growth and events in acute type B aortic dissection

Spinelli

Benedetto

Donato

et al. 2018

Journal of Vascular Surgery

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“…Volume has also been shown to be a predictor of disease progression and need for intervention. Prior studies from our group demonstrated that in patients presenting with acute uncomplicated TBAD, the ratio of true lumen volume to false lumen volume is inversely correlated with eventual intervention after the acute 14-day period [ 20 ]. Initial ratio of true lumen volume to false lumen volume was also inversely correlated with growth in aortic diameter between the time at presentation and follow-up imaging.…”

Section: Discussionmentioning

confidence: 99%

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

Chen

Larion

Ahanchi

et al. 2017

J Cardiothorac Surg

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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.

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“…There are limitations to utilizing strict diameter measurements of the true and false lumen to characterize aortic remodeling and predict aortic enlargement. Our group 26 ) proposed a volumetric analysis of the initial index CT as a method of predicting patients at a high risk of aortic growth who would benefit from an early aortic intervention. Using 3D reconstruction software, initial CT of 117 patients were analyzed.…”

Section: Radiologic Risk Factorsmentioning

confidence: 99%

Uncomplicated Acute Type B Aortic Dissection: Selection Guidelines for TEVAR

Krol

Panneton

2017

Annals of Vascular Diseases

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Traditionally, the surgical management of acute type B aortic dissections was reserved for patients with signs of malperfusion, rapid expansion, retrograde dissection or rupture. The adjunct of endovascular techniques has brought a paradigm shift, leaning towards preventing long term dissection complications. Multiple risk factors have been proposed to identify patients at risk for long term aortic complications. The patients, who are offered a prophylactic endovascular therapy for uncomplicated aortic dissection, should be selected carefully, and offered intervention by an experienced team in a high-volume center. (This is a review article based on the invited lecture of the 57th Annual Meeting of Japanese College of Angiology.)

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

Abstract: Initial CT scan volumetric analysis in patients presenting with uncomplicated acute type B ADs is a useful tool to predict growth and need for future intervention.

Cited by 16 publications

References 23 publications

Current evidence in predictors of aortic growth and events in acute type B aortic dissection

Current evidence in predictors of aortic growth and events in acute type B aortic dissection

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

Uncomplicated Acute Type B Aortic Dissection: Selection Guidelines for TEVAR

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