Radiologic reporting of DeBakey type I aortic dissection: key preoperative and postoperative findings of the AMDS...

The computed tomography (CT) scan is the gold standard imaging for the diagnosis of DeBakey type I aortic dissection (D1AD) as well as for follow-up after surgical repair. Novel endovascular and hybrid repair devices for have been increasingly utilized in recent years for D1AD, such as the AMDS Hybrid Prosthesis (Artivion, Georgia, USA). Herein, we describe the key radiologic findings on the preoperative CT that aids in decision-making regarding use of the AMDS and the pertinent findings of the AMDS on postoperative CT scan. The AMDS is implanted at the time of surgical intervention for D1AD. A transverse aortic incision is made 1cm proximal to the innominate artery and the device is deployed at the distal anastomosis into the aortic arch. Key findings to note on preoperative CT scan that determine suitability for use of the AMDS include the extent of the dissection, location of entry tears, and branch vessel involvement. The design of the AMDS includes a proximal felt sewing cuff with a bare metal stent. Areas that may be of concern in adverse aortic remodeling include distal anastomotic new entry tear (DANE) proximally, although this risk is reduced with the AMDS, tears at the level of the head vessels, stented portion of the aorta, or distal to the stent. Novel devices such as the AMDS have become increasingly utilized in aortic surgery and are accompanied by unique findings on postoperative CT scans that should be understood prior to reviewing such studies.