For PAUs diagnosed on CTA at a single institution, 4.1% were ruptured and 12.9% underwent repair. Close follow-up imaging appears to be indicated for PAUs, particularly in the case of symptomatic disease, which is more likely to require repair and to undergo radiographic progression.

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Relatively low 30-day rehospitalization was accomplished in vascular surgery patients at a single university hospital. Moreover, planned rehospitalizations accounted for approximately 25% of readmissions in vascular surgery patients. Strategies designed to reduce rehospitalization in diabetics may be warranted.

Background Patients with bicuspid aortic valves (BAV) are at increased risk of ascending aortic dilatation, dissection, and rupture. We hypothesized that ascending aortic wall stress may be increased in patients with BAV compared to patients with tricuspid aortic valves (TAV). Methods Twenty patients with BAV and 20 patients with TAV underwent electrocardiogram-gated computed tomography angiography. Patients were matched for diameter. The thoracic aorta was segmented, reconstructed, and triangulated to create a mesh. Utilizing a uniform pressure load of 120 mmHg, and isotropic, incompressible, and linear elastic shell elements, finite element analysis was performed to predict 99th-percentile wall stress. Results For patients with BAV and TAV, aortic root diameter was 4.0 ± 0.6 cm and 4.0 ± 0.6 cm (P=0.724), sinotubular junction diameter was 3.6 ± 0.8 cm and 3.6 ± 0.7 cm (P=.736), and maximum ascending aortic diameter was 4.0 ± 0.8 cm and 4.1 ± 0.9 cm (P=.849), respectively. The mean 99th-percentile wall stress in the BAV group was greater than in the TAV group (0.54 ±0.06 megpascals, MPa, versus 0.50 ± 0.09 MPa), though this did not reach statistical significance (p=0.090). When normalized by radius, the 99th-percentile wall stress was greater in the BAV group (0.31 ± 0.06 MPa/cm versus 0.27 ± 0.03 MPa/cm, P=0.013). Conclusions Patients with BAV, regardless of aortic diameter, have increased 99th-percentile wall stress in the ascending aorta. Ascending aortic three-dimensional geometry may account in part for the increased propensity to aortic dilatation, rupture, and dissection in patients with BAV.

Objective Whereas uncomplicated acute type B aortic dissections are often medically managed with good outcomes, a subset develop subacute or chronic aneurysmal dilation. We hypothesized that computational fluid dynamics (CFD) simulations may be useful in identifying patients at risk for this complication. Methods Patients with acute type B dissection complicated by rapidly expanding aortic aneurysms (N = 7) were compared with patients with stable aortic diameters (N = 7). Three-dimensional patient-specific dissection geometries were generated from computed tomography angiography and used in CFD simulations of pulsatile blood flow. Hemodynamic parameters including false lumen flow and wall shear stress were compared. Results Patients with rapid aneurysmal degeneration had a growth rate of 5.3 ± 2.7 mm/mo compared with those with stable aortic diameters, who had rates of 0.2 ± 0.02mm/mo. Groups did not differ in initial aortic diameter (36.1 ± 2.9 vs 34.4 ± 3.6 mm; P = .122) or false lumen size (22.6 ± 2.9 vs 20.2 ± 4.5 mm; P = .224). In patients with rapidly expanding aneurysms, a greater percentage of total flow passed through the false lumen (78.3% ± 9.3% vs 56.3% ± 11.8%; P = .016). The time-averaged wall shear stress on the aortic wall was also significantly higher (12.6 ± 3.7 vs 7.4 ± 2.8 Pa; P = .028). Conclusions Hemodynamic parameters derived from CFD simulations of acute type B aortic dissections were significantly different in dissections complicated by aneurysm formation. Thus, CFD may assist in predicting which patients may benefit from early stent grafting.