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- Title
Radiographic complicated and uncomplicated descending aortic dissections: aortic morphological differences by CT angiography and risk factor analysis.
- Authors
Berger, Tim; Maier, Annika; Kletzer, Joseph; Schlett, Christopher L; Kondov, Stoyan; Czerny, Martin; Rylski, Bartosz; Kreibich, Maximilian
- Abstract
Aims To identify radiographic differences between patients with uncomplicated and complicated descending aortic dissections. Methods and results Between April 2009 and July 2021, 209 patients with acute descending aortic dissections were analysed as complicated (malperfusion, rupture, diameter progress, and diameter ≥ 55 mm) or uncomplicated. Detailed CTA measurements (slice thickness ≤ 3 mm) were taken in multiplanar reconstruction. A composite endpoint (early aortic failure) was defined as reoperation, diameter progression, and early mortality. Seventy-seven patients were female (36.8%) [complicated n = 27 (36.5%); uncomplicated n = 50 (37.0%) P = 1.00]. Seventy-four (35%) patients were categorized as morphologically complicated, and 135 (65%) as uncomplicated. In patients with complicated dissections, the dissection extended more frequently to the aortic bifurcation (P = 0.044), the coeliac trunk (P = 0.003), the superior mesenteric artery (P = 0.007), and both iliac arteries (P < 0.001) originated less frequently from the true lumen. The length of the most proximal communication (entry) in type B aortic dissection was longer, 14.0 mm [12.0 mm; 27.0 mm] vs. 6.0 mm [4,0 mm; 13.0 mm] in complicated cases (P = 0.005). Identified risk factors for adverse aortic events were connective tissue disease [HR 8.0 (1.9–33.7 95% CI HR)], length of the aortic arch [HR 4.7 (1.5–15.1 95% CI HR)], a false lumen diameter > 19.38 mm [HR 3.389 (1.1–10.2 95% CI HR)], and origin of the inferior mesenteric artery from the false lumen [HR 4.2 (1.0–5.5 95% CI HR)]. Conclusion We identified significant morphological differences and predictors for adverse events in patients presenting complicated and uncomplicated descending dissections. Our morphological findings will help guide future aortic therapies, taking a tailored patient approach.
- Subjects
PEARSON correlation (Statistics); CELIAC artery; RECEIVER operating characteristic curves; T-test (Statistics); RESEARCH funding; AORTIC dissection; BLOOD vessels; COMPUTED tomography; FISHER exact test; LOGISTIC regression analysis; DESCRIPTIVE statistics; MANN Whitney U Test; CHI-squared test; MULTIVARIATE analysis; CONNECTIVE tissue diseases; ILIAC artery; STATISTICS; CONFIDENCE intervals; DATA analysis software; MESENTERIC artery; THORACIC aorta; DISEASE risk factors; DISEASE complications
- Publication
European Heart Journal - Cardiovascular Imaging, 2024, Vol 25, Issue 6, p867
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jeae030