Imaging Surveillance Adherence for Uncomplicated Type B Aortic Dissection at a Regional Referral Center

Area of Science:

• Cardiovascular Surgery
• Medical Imaging
• Public Health

Background:

• Medical management and imaging surveillance are standard for uncomplicated type B aortic dissections (uTBAD).
• Nonadherence to surveillance can lead to aortic degeneration, complications, and increased mortality.
• This study aimed to assess adherence to imaging surveillance and identify associated risk factors.

Purpose of the Study:

• To analyze adherence rates to imaging surveillance in patients with uncomplicated type B aortic dissections (uTBAD).
• To identify demographic, clinical, and logistical factors associated with nonadherence to surveillance protocols.
• To evaluate the impact of surveillance on patient outcomes and interventions.

Main Methods:

• A retrospective cohort study analyzed 152 patients with acute or subacute uTBAD.
• Imaging surveillance was defined as aorta-directed imaging and encounters ≥3 months post-hospitalization.
• Univariate and multivariate logistic regression identified factors related to surveillance adherence.

Main Results:

• Only 46% of patients underwent recommended imaging surveillance.
• Adherence did not correlate with patient demographics or distance from the center.
• Home discharge was associated with higher adherence, while prior cardiovascular surgery, drug use history, and older age were linked to lower adherence.
• Patients with surveillance were more likely to receive postdischarge thoracic endovascular aortic repair (TEVAR).

Conclusions:

• Low adherence to uTBAD imaging surveillance was observed, independent of patient characteristics or geographic distance.
• While surveillance was linked to increased TEVAR, 5-year survival rates were similar between groups.
• Home discharge emerged as a key factor promoting surveillance adherence, highlighting challenges in care coordination for medically managed uTBAD.