Association of circumferential dissection on computed tomography angiography with preoperative rupture in type A aortic dissection

Background To investigate the association between circumferential dissection on computed tomography angiography (CTA) and preoperative rupture in patients with type A aortic dissection (TAAD). Methods This retrospective cohort study included 597 consecutive patients diagnosed with TAAD at Beijing Anzhen Hospital between January 2021 and December 2024. Patients were classified into circumferential dissection (n = 130) and non-circumferential dissection (n = 467) groups based on preoperative CTA. Clinical, laboratory, and imaging characteristics were compared between groups. Univariable and multivariable logistic regression analyses were performed to examine factors independently associated with preoperative rupture, and between-group differences in preoperative rupture were compared. Results Circumferential dissection was strongly associated with DeBakey type I dissection, supra-aortic branch involvement, and greater false-lumen expansion with true-lumen compression. Preoperative rupture occurred more frequently in patients with circumferential dissection than in those without (33.8% vs 7.1%, P < 0.001). Multivariable logistic regression demonstrated that circumferential dissection was independently associated with preoperative rupture ascertained by bedside echocardiography following the admission CTA after adjustment for demographic, laboratory, and imaging factors (OR = 5.24, 95% CI: 1.86-14.76, P = 0.002). Conclusion Circumferential dissection on CTA is independently associated with preoperative rupture and may support timely surgical decision-making in TAAD.