IP241. Adherence to Recommended Imaging Surveillance of Acutely Presenting Stanford Type B Aortic Dissections

Abstract

Acutely presenting Stanford type B aortic dissections (TBADs) primarily receive medical or endovascular management and require lifelong imaging surveillance. Only computed tomography and magnetic resonance imaging adequately assess early indications of fatal developments. For both management strategies, guidelines recommend imaging at months 1, 3, 6, and 12 after discharge from initial admission and annually thereafter. This study aimed to evaluate adherence to recommended imaging surveillance for newly presenting TBAD patients at a tertiary hospital. A retrospective review of patients presenting with a new, acute TBAD between January 2010 and March 2017 was performed. Demographics of the patients, TBAD admission details, and medical histories were obtained from an electronic chart review. Computed tomography and magnetic resonance images were reviewed, and aortic sizes were measured by a single operator. Patients without TBAD surveillance imaging for >15 months were considered lost to follow-up. Overall follow-up (imaging every <15 months) and adherence to recommended surveillance (1 month, 3 months, 6 months, 12 months, and annually) were analyzed using Kaplan-Meier graphs. Log-rank analysis assessed factors increasing risk of poor follow-up and adherence to guidelines. Sixty-two patients (38 male, 24 female) were included. At the time of initial admission, median age was 62 years, and median aortic diameter was 44 mm. Median duration of overall follow-up was 24 months. Kaplan-Meier analysis of overall follow-up, censoring death and external follow-up, indicated follow-up rates of 87.1% (standard error, 4.3%) at 1 month and 3 months, 85.2% (4.6%) at 6 months, 77.5% (5.6%) at 12 months, and 63.8% (8.1%) at 60 months (Fig 1). However, similar analysis of adherence to recommended imaging interval guidelines revealed compliance of 10.9% (standard error, 4.2%) at 3 months, 8.7% (3.9%) at 6 months, and 0.0% (0.0%) at 12 months (Fig 2). Log-rank analysis indicated that specialty arranging follow-up, medical (n = 24) vs surgical (n = 38), did not have an impact on overall follow-up or adherence to recommended guidelines. Similarly, patient’s distance to the hospital, medical vs endovascular intervention, initial dissection size, smoking history, or additional medical/demographic characteristics did not affect these outcomes. At our institution, overall follow-up of TBAD is satisfactory; however, the frequency of imaging surveillance does not adhere to published, recommended guidelines. This concerns all TBAD patients and no subset in isolation. Imaging surveillance with stricter intervals can improve the quality of patient outcomes. This presents an opportunity for education on recommended guidelines and implementation of a protocol to notify physicians when imaging is recommended, especially in the era of linked health care payment to quality measures.Fig 2Kaplan-Meier curve of adherence to recommended Stanford type B aortic dissection (TBAD) imaging surveillance schedule. CI, Confidence interval.View Large Image Figure ViewerDownload Hi-res image Download (PPT)