Aortic Geometric Alteration Associated With Acute Type B Aortic Dissection: Angulation, Tortuosity, and Arch Type.

Likun Sun,Hao He,Quanming Li,Lunchang Wang,Ming Li,Xin Li,Chang Shu,Xiaolong Zhang,Tun Wang,Jiehua Li,Chenglei Zhao

doi:10.3389/fphys.2021.708651

Abstract

Background: Acute type B aortic dissection is a highly serious aortic pathology. Aortic geometric parameters may be useful variables related to the occurrence of acute type B aortic dissection (aTBAD). The aim of the study is to delineate the alteration in aortic geometric parameters and analyze the specific geometric factors associated with aTBAD.Methods: The propensity score matching method was applied to control confounding factors. The aortic diameter, length, angulation, tortuosity, and type of aortic arch of the aTBAD and control group were retrospectively analyzed via three-dimensional computed tomography imaging created by the 3mensio software (version 10.0, Maastricht, The Netherlands). The geometric variables of true lumen and false lumen in the descending aorta were measured to estimate the severity of aortic dissection. Multivariable logistic regression models were used to investigate the significant and specific factors associated with aTBAD occurrence. The area under the receiver operating characteristic curve (AUC) was used to estimate the performance of the model.Results: After propensity score matching, 168 matched pairs of patients were selected. The ascending aorta and aortic arch diameters were dilated, and the ascending aorta and total aorta lengths were elongated in aTBAD group significantly (P < 0.001). The ascending aorta and aortic arch angulations in the aTBAD group were sharper than those of the controls (P = 0.01, P < 0.001, respectively). The aortic arch and total aorta tortuosities were significantly higher in the aTBAD group (P = 0.001, P < 0.001, respectively). There were more type III arch patients in the aTBAD group than the controls (67.9 vs. 22.6%). The true lumen angulation was sharper than that in the false lumen (P < 0.01). The true lumen tortuosity was significantly lower than that in the false lumen (P < 0.001). The multivariable models identified that aortic arch angulation, tortuosity, and type III arch were independent and specific geometric factors associated with aTBAD occurrence. The AUC of the multivariable models 1, 2, 3 were 0.945, 0.953, and 0.96, respectively.Conclusions: The sharper angulation and higher tortuosity of aortic arch and type III arch were the geometric factors associated with aTBAD in addition to the ascending aorta elongation and aortic arch dilation. The angulation and tortuosity of the true and false lumens may carry significant clinical implications for the treatment and prognosis of aTBAD.

Highlights

Acute type B aortic dissection is an emergency and lifethreatening vascular disease that involves the separation of the aortic wall layers (Nienaber and Clough, 2015)
The inclusion criterion for the group with acute type B aortic dissection (aTBAD) was that the computed tomography angiography (CTA) examination was performed within 2 weeks of onset
We found that the diameters of the distal ascending aorta and distal brachiocephalic trunk (BCT), the length of the ascending aorta, and the angulation of the aortic arch were independently associated with aTBAD in model 1

Summary

Introduction

Acute type B aortic dissection is an emergency and lifethreatening vascular disease that involves the separation of the aortic wall layers (Nienaber and Clough, 2015). With the rapid development of interventional devices and surgical methods in the past 20 years, the overall in-hospital mortality rate of type B aortic dissection is still as high as 13% (Evangelista et al, 2018). Previous studies have illustrated that geometric variables such as the diameter, length, angulation, and tortuosity of ascending aorta were key risk factors for the development of type A aortic dissection (Kruger et al, 2016; Heuts et al, 2018; Gode et al, 2019; Jie et al, 2021; Saade et al, 2021). It has been gradually recognized that these geometric features may be associated with the onset of acute type B aortic dissection (aTBAD). Aortic geometric parameters may be useful variables related to the occurrence of acute type B aortic dissection (aTBAD). The aim of the study is to delineate the alteration in aortic geometric parameters and analyze the specific geometric factors associated with aTBAD

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