A Prospective Study of Medically Treated Acute Type B Aortic Dissection

Winnerkvist, Anders; Lockowandt, Ulf; Rasmussen, Erik; Rådegran, Kjell

doi:10.1016/j.ejvs.2006.04.004

Cited by 168 publications

(68 citation statements)

References 21 publications

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“…For example, predisposing factors of early and late complications in uncomplicated type B aortic dissection have been proposed based on morphological changes, such as the patency of the false lumen in the follow-up, an initial aortic diameter C4 cm with a patent false lumen, and an initial false lumen diameter C22 mm in the proximal descending aorta. Partial false lumen thrombosis, a proximal entry tear size [10 mm, and a spiral configuration of the dissection have also been suggested to be risk factors of aortic growth [14][15][16][17]. The structural morphology that is being captured by imaging represents the outcome of the underlying hemodynamic condition, and also the cause of subsequent hemodynamic condition.…”

Section: Discussionmentioning

confidence: 99%

The Potential of Computational Fluid Dynamics Simulation on Serial Monitoring of Hemodynamic Change in Type B Aortic Dissection

Wong

et al. 2016

Cardiovasc Intervent Radiol

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Section: Discussionmentioning

confidence: 99%

The Potential of Computational Fluid Dynamics Simulation on Serial Monitoring of Hemodynamic Change in Type B Aortic Dissection

Wong

et al. 2016

Cardiovasc Intervent Radiol

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“…A number of anatomic features of the dissected aorta have also been found to be predictive of increased risk: a patent false lumen (3); those with a maximal aortic diameter of Ͼ4 cm at presentation (3,5); and those who have an intramural hematoma with localized dissection and/or ulcer-like projections on CT scan. Conversely, those with pure intramural hematoma and no evident communication with the aortic lumen are at very low risk (5).…”

Section: See Page 799mentioning

confidence: 97%

“…With regard to medically managed type III aortic dissection, in the experience of the International Registry of Acute Aortic Dissection (IRAD), the 3-year survival was 77% (4). Alternatively, in a prospective study, medically managed acute type III aortic dissection in Sweden, the 10-year survival was higher at 82% at 5 years and 69% at 10 years, and only slightly below that of the age-and gender-matched general population, and most of the patients actually died of causes unrelated to their dissections (5).…”

Section: See Page 799mentioning

confidence: 98%

“…The mechanisms by which stent-grafting might improve late outcomes is hypothesized to be as follows: the stent-graft is deployed in the proximal descending thoracic aorta, reapposing the dissected layers of the aorta and covering over the site of intimal tear (entry site); this prevents blood flow into the false lumen, resulting in decompression and thrombosis of the false lumen, which should be favorable as numerous reports have found that a thrombosed false lumen predicts lower aortic event rates (4,9) and a reduction in aortic diameter (5). Additionally, covering over the intimal tear could potentially reduce the risk of retrograde extension of a type III aortic dissection into the ascending aorta.…”

Section: See Page 799mentioning

confidence: 99%

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Dissection of the Descending Thoracic Aorta

Isselbacher¹

2007

Journal of the American College of Cardiology

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In this issue of the Journal, Song et al.(1) report a retrospective analysis of the midterm outcomes of 100 patients with an acute aortic dissection involving the descending thoracic aorta. Of the 100, 51 had a DeBakey type I (involvement of both the ascending and descending thoracic aorta) aortic dissection and underwent early repair of the ascending thoracic aorta, and 49 had a DeBakey type III (no involvement of the ascending aorta) aortic dissection. The subjects were followed longitudinally with serial computed tomography (CT) scans for a mean of 31 months, and were followed clinically for a mean of 53 months. Among a subset of 53 subjects who had aortic imaging repeated beyond 2 years, an aortic aneurysm developed in 28%, with the majority of aneurysms involving the proximal segment of the descending thoracic aorta. The proximal segment also grew most rapidly, at rate of 3.4 Ϯ 3.6 mm/year. There was a trend toward slightly faster rates of aortic growth among those with type I versus type III dissection, at 3.8 Ϯ 3.5 mm/year versus 3.1 Ϯ 3.1 mm/year, respectively. See page 799The authors measured both total aortic diameter and the diameter of the false lumen alone at multiple levels in the aorta. Although overall aortic diameter was a predictor of aortic aneurysm formation, it was not found to be an independent predictor on multivariate analysis. Instead, they found that Marfan syndrome and large false lumen diameters at the upper and mid-descending thoracic aorta were independent predictors of late aneurysm formation. Dividing their populations into those with a small false lumen diameter (Ͻ21 mm) and those with a large false lumen diameter (Ն22 mm) in the upper descending thoracic aorta, they demonstrated that those with a large false lumen had a markedly greater risk of late aneurysm formation (42% vs. 5%, p Ͻ 0.001), with a trend toward increased mortality (17% vs. 5%, p ϭ 0.09) as well.So why are these findings so important? To put these findings into clinical perspective, it is best to step back and consider our current understanding of the management and outcome of distal aortic dissection.It is well established that those with aortic dissection involving the ascending thoracic aorta (DeBakey types I and II, or Stanford type A) are at high risk of early death, as the dissected ascending aorta has a propensity to rupture into the pericardial space. Consequently, such patients are managed with early surgical repair of the ascending thoracic aorta, as decades of data have validated the advantage of surgery over medical therapy for this group.Conversely, those with aortic dissections involving the descending aorta but not the ascending aorta (DeBakey type III, Stanford type B) have a relatively low risk of aortic rupture and, thus, have a significantly lower early mortality. Moreover, surgery to repair the descending thoracic aorta in this setting is associated with substantial mortality and morbidity, including the dreaded complication of paraplegia. Therefore, since surgery was shown to confer no surviv...

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“…Several retrospective studies have sought to identify these risk factors. Specifically, aortic diameter of > 4 cm at initial CT scan, 33 false lumen diameter of > 22 mm, 34 influence of patent or partial false lumen thrombosis, 35 size of proximal entry tear, 36 location of primary tear along the convex portion of the aorta, 37 along with ongoing pain 11 are all risk factors for worse prognosis and likelihood of aortic complications. Uncontrolled hypertension appears to be am additional risk factor for worse prognosis.…”

Section: Blurring Lines Between Complicated and Uncomplicatedmentioning

confidence: 99%