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Author Notes:

Correspondence: Bradley G. Leshnower, MD, Assistant Professor of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, 1365 Clifton Rd NE, Ste A2257, Atlanta, GA 30322 bleshno@emory.edu

Conception and design: JC, BL. Analysis and interpretation: JC, YD, JB, RM, WJ, BL. Data collection: JC, XL, YD, EC, WJ, BL. Writing the article: JC, JB, RM, WJ, BL. Critical revision of the article: JC, XL, YD, EC, JB, RM, WJ, BL. Final approval of the article: JC, XL, YD, EC, JB, RM, WJ, BL. Statistical analysis: JC, JB, RM, BL. Obtained funding: Not applicable. Overall responsibility: BL.

Disclosures: Y.M.D. consults and does research support for Cook and Medtronic. E.P.C. is on CryoLife speakers bureau. B.G.L. is on Medtronic speakers bureau.

The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest.

Subjects:

Research Funding:

Not applicable.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Surgery
  • Peripheral Vascular Disease
  • Cardiovascular System & Cardiology
  • Aortic dissection
  • Endovascular procedures
  • False Lumen
  • Endovascular repair
  • Entry tear
  • Thrombosis

The distance of the primary intimal tear from the left subclavian artery predicts aortic growth in uncomplicated type B aortic dissection

Tools:

Journal Title:

Journal of Vascular Surgery

Volume:

Volume 69, Number 3

Publisher:

, Pages 692-700

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objective: Controversy exists about the optimal treatment of acute uncomplicated type B aortic dissection (auTBAD). Optimal medical therapy (OMT) provides excellent short-term outcomes, but long-term results are poor. Ideally, auTBAD patients who will fail to respond to OMT in the chronic phase could be identified and undergo thoracic endovascular aortic repair. The purpose of this study was to identify radiographic predictors of auTBAD patients who will fail to respond to OMT. Methods: A review of the Emory aortic database from 2000 to 2017 identified 320 auTBAD patients initially treated with OMT. From this cohort, 121 patients with two or more contrast-enhanced imaging scans were available for analysis. These patients were initially divided into groups based on growth of the thoracic aorta ≥10 mm or intervention due to aneurysmal growth: growth (n = 72) and no growth (n = 49). TeraRecon (Foster City, Calif) imaging software was used to analyze characteristics of the primary intimal tear (PIT), false lumen, and overall aortic size. Finally, Cox proportional hazards models were constructed to estimate hazard ratios and to identify predictors of OMT failure. Results: The mean age of all patients was 54 ± 11 years, and 67% were male. Thirty-eight patients (53%) in the growth group underwent intervention. There were no differences between groups in age, hypertension, diabetes mellitus, tobacco abuse, or chronic obstructive pulmonary disease. The distance of the PIT from the left subclavian artery in patients with auTBAD was significantly shorter in the growth group (growth, 27 mm [9-66 mm]; no growth, 77 mm [26-142 mm]; P <.01). Multivariable Cox regression analysis identified the distance of the PIT from the left subclavian artery and a thoracic aortic diameter >45 mm as independent predictors of failure of OMT. Partial false lumen thrombosis was not a predictor of aortic growth. Conclusions: The distance of the PIT from the left subclavian artery is a predictor of aortic growth in auTBAD. Patients with a primary tear located in zone 3 of the proximal descending thoracic aorta should be monitored closely and may be considered for early thoracic endovascular aortic repair in the setting of auTBAD.

Copyright information:

© 2018 by the Society for Vascular Surgery. Published by Elsevier Inc.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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