Comparison of Outcome in Aortic Dissection with Single False Lumen versus Multiple False Lumens: CT Assessment

Abstract

To investigate the clinical features and outcomes of type B multibarreled (multiple false lumens) aortic dissection (AD) compared with those of double-barreled (single false lumen) AD by using computed tomography (CT). The ethics committee approved this study. Informed consent was waived. A total of 221 consecutive patients (127 men; median age, 62 years) with acute type B AD were evaluated by using CT. The clinical outcome, including AD-related events, AD-related deaths, and long-term survival, was retrospectively reviewed and compared with that of patients with double-barreled AD during the follow-up period (median, 60 months). Survival analysis was performed by using Kaplan-Meier analysis with the log-rank test within 10 years after onset. The Cox proportional hazards model was used to estimate the risk for AD-related events and death. In 201 of 221 patients (91.0%), double-barreled AD was identified at initial CT. In 20 of 221 patients (9%), multibarreled AD was identified at initial CT (n = 16) and follow-up CT (n = 4). In 15 of 20 patients (75%) with multibarreled AD, AD-related events occurred, and nine patients (45%) died of AD-related complications. Patients with multibarreled AD showed significantly poorer survival rates than patients with double-barreled AD (P = .0002). The presence of a multibarreled false lumen was the most powerful risk factor for AD-related deaths according to multivariate analysis (hazard ratio, 5.61; 95% confidence interval: 2.44, 12.90; P < .0001). Multibarreled AD occurs in 9% of acute type B dissections. The presence of multibarreled AD is a powerful predictor of AD-related deaths.