Prevalence of the computed tomographic morphological DISSECT predictors in uncomplicated Stanford type B aortic dissection
Objective/Background - The aim was to analyse the prevalence of computed tomographic (CT) morphological predictors and their influence on early chronic phase aortic diameter expansion in patients with uncomplicated acute Stanford type B aortic dissection (ATBAD). - Methods - This retrospective analy...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
26 July 2018
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| In: |
European journal of vascular and endovascular surgery
Year: 2018, Volume: 56, Issue: 4, Pages: 525-533 |
| ISSN: | 1532-2165 |
| DOI: | 10.1016/j.ejvs.2018.06.033 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.ejvs.2018.06.033 Verlag, lizenzpflichtig, Volltext: http://www.sciencedirect.com/science/article/pii/S1078588418303927 
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| Author Notes: | Marius Ante, Spyridon Mylonas, Denis Skrypnik, Moritz S Bischoff, Fabian Rengier, Jan Brunkwall, Dittmar Böckler |
| Summary: | Objective/Background - The aim was to analyse the prevalence of computed tomographic (CT) morphological predictors and their influence on early chronic phase aortic diameter expansion in patients with uncomplicated acute Stanford type B aortic dissection (ATBAD). - Methods - This retrospective analysis reviewed the CT imaging of 140 patients admitted with uncomplicated ATBAD to two tertiary centres between March 2003 and April 2016. The prevalence of the following CT-morphological predictors was determined at baseline: primary entry tear (PET) diameter ≥ 10 mm, its location at the concavity of the aortic arch; maximum descending aortic diameter ≥ 40 mm; false lumen (FL) diameter ≥ 22 mm; partial FL thrombosis and a fusiform index (FI) of ≥0.64. Thoracic aortic diameter expansion (ADE) was evaluated in 65 patients treated by best medical therapy (BMT) (median CT follow up 11.6 months). Study end points were predictor prevalence and ADE. - Results - A mean ± SD of 2.45 ± 1.35 predictors were registered among all 140 patients; 75.0% of patients showed at least two predictors. In 7.9% of patients, no predictor was found. The prevalence of PET at the arch concavity was 18.6%, PET diameter ≥10 mm in 60.0%, maximal descending aortic diameter ≥40 mm in 51.4%, FL diameter ≥22 mm in 47.9%, partial FL thrombosis in 47.9%, and FI ≥ 0.64 in 20.7%. An ADE ≥5 mm was observed in 38 of 65 patients. Median observed ADE was 5.1 mm (median follow up (FU) 11.6 months, range −3.2-27.4 mm). Regression analysis for multiple predictors showed a basic ADE of 2.5 mm plus 1.9 mm per predictor at the median FU of 11.6 months (2.5 mm ± 1.9; 95% confidence interval CI -0.2-5.2 mm ± 0.7-3.0 mm; p = .003). - Conclusion - In the majority of patients, at least one of the investigated morphological predictors of disease progression in uncomplicated ATBAD was detected. An ADE ≥5 mm affected 38 of 65 BMT patients. CT based predictors help to define TBAD patients at risk of progression. |
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| Item Description: | Gesehen am 29.05.2020 |
| Physical Description: | Online Resource |
| ISSN: | 1532-2165 |
| DOI: | 10.1016/j.ejvs.2018.06.033 |