Clinical and Radiographic Sex Related Difference in Patients with Acute Type B and Non-A Non-B Aortic Dissections

The aim of this study was to evaluate clinical and radiographic differences between men and women with acute type B aortic dissection (TBAD) and non-A non-B aortic dissection (AD).

This was a retrospective analysis of patients treated between 2009 and 2022 at a single aortic centre, following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Patients with acute TBAD and non-A non-B AD were included. Clinical characteristics, management, outcomes, and imaging findings were compared between sexes. Computed tomography scans were analysed using multiplanar reconstruction. Patients with previous AD or death before admission were excluded. Univariable Cox regression identified mortality predictors; variables with p < .10 were entered into a multivariable model. Sex risk factor interactions were explored.

Among 236 patients (151 men, 85 women), age did not differ significantly (p = .30). Women had higher rates of heritable thoracic aortic disease (15% vs. 6.6%; p = .031) and aortic rupture (16% vs. 6.0%; p = .011). Dissection morphology and relative dimensions were comparable between sexes. Absolute aortic dimensions were larger in men (p < .001). Regarding high risk features, a difference was observed for aortic diameter > 40 mm (57% vs. 76.2%; p = .002). Treatment strategies were comparable between groups, with an overall intervention rate of 75% (including thoracic endovascular aortic repair and open repair) (p = .80). Sex was a univariable mortality risk factor (p = .013), while multivariable analysis identified malperfusion and acute aortic rupture as independent predictors. Women had worse five year survival (log rank p = .009).

Baseline aortic anatomy, management strategies, and early outcomes were similar between women and men. However, women demonstrated significantly worse five year survival. These findings suggest sex related differences in long term outcomes and highlight the need for further investigation into sex specific risk stratification, disease mechanisms, and follow up strategies.