Radiographic complicated and uncomplicated descending aortic dissections: aortic morphological differences by CT
Tim Berger1,2, Annika Maier1,2, Joseph Kletzer1,2
1Department of Cardiovascular Surgery, University Heart Centre Freiburg, University Medical Centre Freiburg, Südring 15, 79189 Bad Krozingen, Freiburg, Germany.
Insights
Radiographic differences in descending aortic dissections reveal distinct morphological features in complicated cases. These findings aid in predicting adverse events and tailoring patient treatment for better outcomes.
Area of Science:
- Cardiovascular Imaging
- Thoracic Surgery
- Radiology
Background:
- Descending aortic dissections (DAD) present a spectrum of severity, ranging from uncomplicated to complicated forms.
- Complicated DAD is associated with significant morbidity and mortality, necessitating accurate risk stratification.
- Radiographic assessment plays a crucial role in differentiating these subtypes and guiding therapeutic decisions.
Purpose of the Study:
- To delineate the key radiographic and morphological differences between uncomplicated and complicated descending aortic dissections.
- To identify imaging predictors associated with adverse aortic events in patients with DAD.
- To inform tailored treatment strategies based on specific imaging findings.
Main Methods:
- Analysis of computed tomography angiography (CTA) data from 209 patients with acute DAD between April 2009 and July 2021.
- Detailed CTA measurements were performed using multiplanar reconstruction with a slice thickness of ≤ 3 mm.
- Patients were classified as complicated based on criteria including malperfusion, rupture, diameter progression, or a diameter ≥ 55 mm.
Main Results:
- Thirty-five percent of patients had morphologically complicated dissections (n=74), while 65% had uncomplicated dissections (n=135).
- Complicated dissections more frequently involved the aortic bifurcation, celiac trunk, superior mesenteric artery, and iliac arteries.
- A longer entry tear length (>14.0 mm) and origin of the inferior mesenteric artery from the false lumen were associated with complicated dissections.
- Risk factors for adverse events included connective tissue disease, aortic arch length, false lumen diameter > 19.38 mm, and inferior mesenteric artery origin from the false lumen.
Conclusions:
- Significant morphological differences exist between complicated and uncomplicated descending aortic dissections on CTA.
- Specific imaging findings, such as entry tear length and visceral artery involvement, predict adverse aortic events.
- These morphological insights are valuable for guiding individualized therapeutic approaches in DAD management.
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.
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