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The Role of Spatial Aortic Arch Architecture in Type B Aortic Dissection
Joscha Mulorz1, Franziska Garcon1, Amir Arnautovic1
1Clinic for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany.
Journal of Clinical Medicine
|September 28, 2023
Summary
Type B aortic dissection (TBAD) is linked to distinct aortic arch geometry, including steeper angles and increased torsion of supra-aortic branches. These findings may help identify individuals at higher risk for TBAD.
Area of Science:
- Cardiovascular Science
- Medical Imaging
- Anatomy
Background:
- The incidence of Type B aortic dissection (TBAD) is rising globally, yet its underlying causes remain unclear.
- Understanding the geometric variations in the aortic arch may offer insights into TBAD pathogenesis.
Purpose of the Study:
- To investigate and compare the geometric architecture of the aortic arch and its branches in patients with TBAD versus those with carotid stenosis (CS).
- To identify specific aortic arch morphological features associated with TBAD.
Main Methods:
- Retrospective analysis of computer-assisted tomography (CAT) scans from 199 patients (85 TBAD, 114 CS).
- Measurement of aortic arch parameters and supra-aortic branch take-off angles using centerline normalization.
- Calculation of compression (C-index) and torsion (T-index) to assess aortic arch tortuosity.
Main Results:
- TBAD patients exhibited a higher prevalence of type III aortic arch configurations and a steeper aortic arch angle.
- Significant differences in take-off angles of the left carotid artery (LCA) and left subclavian artery (LSA) were observed in TBAD patients.
- Increased inter-vessel distance and a higher T-index in TBAD patients indicated significant torsion of supra-aortic branches.
Conclusions:
- Specific geometric configurations of the aortic arch are associated with TBAD and differ from those in CS patients.
- These findings may aid in identifying individuals with high-risk aortic arch morphology for TBAD.
- Further research is needed to confirm the pathogenetic relevance and causality of these geometric variations.
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