Number of Entry Tears Is Associated With Aortic Growth in Type B Dissections
Number of Entry Tears Is Associated With Aortic Growth in Type B Dissections
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DOI：
10.1016/j.athoracsur.2013.03.087
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发表时间：
2013-07-01
影响因子：
4.6
通讯作者：
Muhs, Bart E.
中科院分区：
文献类型：
--
作者：
Tolenaar, Jip L.;van Keulen, Jasper W.;Muhs, Bart E.
背景急性B型主动脉夹层（ABAD）的主动脉生长率是主动脉并发症和死亡的重要预测因子。为了改善总体结果，放射学预测因素可能会将受益于成功医疗管理的患者与需要干预的患者进行分层。本研究调查了ABAD患者中可识别的入口撕裂的数量是否与主动脉生长相关。对临床状况不复杂并因此接受药物治疗的ABAD患者进行了评价。纳入了在临床表现时获得计算机断层扫描血管造影（CTA）和随后在药物治疗后至少90天获得CTA的患者（2005年至2010年）。研究CTA的真腔和假腔之间的入口撕裂数量。在基线和最后一次可用的随访CTA上测量五个水平的夹层动脉瘤直径，并计算年主动脉生长率。将这些患者中入口撕裂的数量和在主动脉中的位置与主动脉生长速率进行比较。纳入了60例患者，共出现243个夹层节段。随访期间（中位数，23.2;范围，3 - 132个月），1处入口撕裂（5.6 ± 8.9 mm）的患者的平均生长率显著高于2处（2.1 ± 1.7 mm; p = 0.001）和3处入口撕裂（平均2.2 ± 4.1; p = 0.010）的患者。主动脉入口撕裂与左锁骨下动脉的距离对主动脉生长率没有影响（中位数，38;四分位距，24 - 137 mm; p = 0.434）。临床表现后首次CTA检测到的ABAD患者的入口撕裂数量是主动脉生长的重要预测因素。出现1处入口撕裂的患者显示出比其他患者更高的生长速率，并且可能受益于更严格的监测或早期预防性干预。(C)2013年由胸外科医师协会
Background. Aortic growth rate in acute type B aortic dissection (ABAD) is a significant predictor for aortic complications and death. To improve the overall outcome, radiologic predictors might stratify patients who benefit from successful medical management vs those who require intervention. This study investigated whether the number of identifiable entry tears in ABAD patients is associated with aortic growth.Methods. ABAD patients with uncomplicated clinical conditions and therefore treated with medical therapy were evaluated. Those with a computed tomography angiography (CTA) obtained at clinical presentation and a subsequent CTA obtained at least 90 days after medical treatment were included (2005 to 2010). The CTAs were investigated for the number of entry tears between the true and false lumen. Diameters of the dissected aortas were measured at five levels on the baseline and on the last available follow-up CTA, and annual aortic growth rates were calculated. The number of entry tears in these patients and the location in the aorta were compared with the aortic growth rate.Results. Included were 60 patients who presented with 243 dissected segments. Mean growth rates during follow-up (median, 23.2; range, 3 to 132 months) were significantly higher in patients with 1 entry tear (5.6 +/- 8.9 mm) than in those with 2 (2.1 +/- 1.7 mm; p = 0.001) and 3 entry tears (mean 2.2 +/- 4.1; p = 0.010). The distance of the primary entry tear from the left subclavian artery did not have an effect on the aortic growth rate (median, 38; interquartile range, 24 to 137 mm; p = 0.434).Conclusions. The number of entry tears in ABAD patients detected on the first CTA after clinical presentation is a significant predictor for aortic growth. Patients with 1 entry tear at presentation show a higher growth rate than other patients and might benefit from more strict surveillance or early prophylactic intervention. (C) 2013 by The Society of Thoracic Surgeons