Factors Predicting Aneurysmal Degeneration of Medically Managed Type B Aortic Dissections

Abstract

Introduction: Aneurysmal degeneration of medically managed type B aortic dissection (TBAD) can be a life-threatening condition. Preventive thoracic endovascular aorta repair (TEVAR) in patients at risk could potentially be beneficial. A number of predictive factors for aneurysmal degeneration of medically managed type B aortic dissections have already been described in literature. However, no study yet has revised these risk factors coupled to the aortic dissection risk tool (Stanford Aortic Dissection Risk Calculator) developed by Sailer et al 1 The objectives of this study is to examine the predictors for late aneurysmal dilatation after TBAD. Methods: A retrospective study was conducted on 100 patients initially treated medically for acute TBAD. Relevant demographic, biochemical and radiographic variables at presentation were studied. The aortic dissection risk calculator tool developed by Sailer et al.1, predicting the risk of adverse events after aortic dissection based on demographic and radiographic variables at presentation, was tested retrospectively. Results: With a median follow-up of 36 months (range 13-76), 43 patients underwent surgery (72.1% TEVAR). A larger initial aortic and false lumen diameter as well as a greater distal extension of the dissection was associated with higher need for surgery (respectively, p=0.004, p=0.020 and p=0.003). A more specific predictor for TEVAR was an initial aortic diameter above 40mm (p=0.024). Higher growth rates of the maximum aortic diameter were observed with a greater distal extension of the dissection, larger false lumen diameters and false lumen outflow, and entry tears located at the inner aortic arch (respectively, p=0.002, p=0.011, p=0.046 and p=0.027). No significant correlations were found for the absolute and relative risks provided by the calculator tool. Conclusion: The initial maximum aortic diameter of the aortic dissection is a key predictor for aortic growth. Furthermore, the distal extension of the aortic dissection also seems to play an important role in late aneurysmal degeneration. However, we were not able to confirm the added value of the risk calculator tool in general practice. A prospective study is needed with more uniform data collection and follow-up imaging. Disclosure: Nothing to disclose