Key result
An initial false lumen diameter ≥22 mm at the upper descending thoracic aorta was associated with a significantly higher rate of late aneurysm or death compared to smaller diameters (P<0.001).
Why the study?
Aneurysmal dilation of the descending aorta is a critical late complication in patients with acute aortic dissection, but long-term predictors are not well defined.
Cohort (n=100)
Answers are grounded in this paper and cite their sources.
An initial false lumen diameter ≥22 mm at the upper descending thoracic aorta is a strong predictor of late aneurysmal dilation and adverse outcomes in patients with acute aortic dissection, warranting close surveillance.
OBJECTIVES: We sought to demonstrate the long-term natural course of descending aorta dilation after acute aortic dissection (AD) and identify early predictors for late aneurysmal change. BACKGROUND: Aneurysmal dilation of the aorta is a critical late complication in AD patients. METHODS: Contrast-enhanced computed tomography (CT) was performed during the acute phase in 100 AD patients, comprising 51 type 1 who underwent ascending aorta surgery and 49 type 3 AD patients. Clinical observation was conducted for 53 +/- 26 months, and CT was repeated for 31 +/- 27 months. RESULTS: Aneurysm (diameter > or =60 mm) occurred in 14.4%, 8.2%, 4.1%, and 3.1% of patients at the upper descending thoracic aorta (UT), mid descending thoracic aorta (MT), lower descending thoracic aorta (LT) and abdominal aorta (AA), respectively. Of 53 patients in whom CT was repeated for > or =2 years, the rates of aorta diameter enlargement at the UT, MT, LT, and AA levels were 3.43 +/- 3.66 mm/year, 3.21 +/- 2.70 mm/year, 2.62 +/- 2.19 mm/year, and 1.93 +/- 3.13 mm/year, respectively (p < 0.01), and aneurysm developed in 15 (28%). The initial false lumen diameter at the UT, the aorta diameter at the MT, and Marfan syndrome were independent predictors of late aneurysm. A > or =22-mm initial false lumen diameter at the UT predicted late aneurysm with a sensitivity of 100% and a specificity of 76%. The patients with initial UT false lumen diameter > or =22-mm (n = 42) showed higher event rate (aneurysm or death) than others (n = 58) (p < 0.001). CONCLUSIONS: The UT is the major site of late aneurysmal dilation. A large UT false lumen diameter on the initial CT portends late aneurysm and adverse outcome warranting early intervention.
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Song et al. (2007) conducted a cohort in Acute aortic dissection (n=100). Initial false lumen diameter ≥22 mm at the upper descending thoracic aorta vs. Initial false lumen diameter <22 mm was evaluated on Late aneurysm or death (p=< 0.001). An initial false lumen diameter ≥22 mm at the upper descending thoracic aorta was associated with a significantly higher rate of late aneurysm or death compared to smaller diameters (P<0.001).
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