Tatsuya Oda1, Kenji Minatoya2, Hiroaki Sasaki1, Hiroshi Tanaka1, Yoshimasa Seike1, Tatsuya Itonaga1, Yosuke Inoue1, Masahiro Higashi1, Kunihiro Nishimura1, Junjiro Kobayashi1. 1. From the Department of Cardiovascular Surgery (T.O., K.M., H.S., H.T., Y.S., T.I., Y.I., J.K.), Department of Radiology (M.H.), and Department of Preventive Medicine and Epidemiology (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan. 2. From the Department of Cardiovascular Surgery (T.O., K.M., H.S., H.T., Y.S., T.I., Y.I., J.K.), Department of Radiology (M.H.), and Department of Preventive Medicine and Epidemiology (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan. minatoya@ncvc.go.jp.
Abstract
BACKGROUND: To address the lack of information about the size of ruptures associated with chronic dissection in the descending and thoracoabdominal aorta, we evaluated the natural history of this pathology. METHODS AND RESULTS: We analyzed data from 571 patients (mean age, 69.4±11.6 years) with unrepaired chronic aortic dissection in the descending or thoracoabdominal aorta with a maximal aortic diameter of ≥3.5 cm from 2007 to 2014. This was a cross-sectional study. Data on the timing of computed tomographic scan were as follows: for ruptured cases: at the time of rupture; for nonruptured cases: the initial aortic diameter. Patients with connective tissue disorders were excluded. The primary end point was evidence of aortic rupture on computed tomographic images. The median maximal diameter was 4.3 cm (limits, 3.5-9.0 cm) for all aortas and 5.6 cm (n=31; limits, 3.6-8.0 cm) for ruptured aortas. For aortic diameters of 4.0 to 4.4, 4.5 to 4.9, 5.0 to 5.4, 5.5 to 5.9, and 6.0 to 6.4 cm, the incidence of rupture was 0%, 3.3%, 15.3%, 18.8%, and 28.6%, respectively. The risk factors for rupture were absence of hypertension, chronic heart failure, chronic-phase dissection, and Yale index. CONCLUSIONS: The risk of aortic rupture increased with an aortic diameter of ≥5.0 cm in patients with chronic aortic dissection in the descending or thoracoabdominal aorta. We would recommend 5.0 cm as an acceptable size for elective resection of subacute or chronic aortic dissection in the descending or thoracoabdominal aorta.
BACKGROUND: To address the lack of information about the size of ruptures associated with chronic dissection in the descending and thoracoabdominal aorta, we evaluated the natural history of this pathology. METHODS AND RESULTS: We analyzed data from 571 patients (mean age, 69.4±11.6 years) with unrepaired chronic aortic dissection in the descending or thoracoabdominal aorta with a maximal aortic diameter of ≥3.5 cm from 2007 to 2014. This was a cross-sectional study. Data on the timing of computed tomographic scan were as follows: for ruptured cases: at the time of rupture; for nonruptured cases: the initial aortic diameter. Patients with connective tissue disorders were excluded. The primary end point was evidence of aortic rupture on computed tomographic images. The median maximal diameter was 4.3 cm (limits, 3.5-9.0 cm) for all aortas and 5.6 cm (n=31; limits, 3.6-8.0 cm) for ruptured aortas. For aortic diameters of 4.0 to 4.4, 4.5 to 4.9, 5.0 to 5.4, 5.5 to 5.9, and 6.0 to 6.4 cm, the incidence of rupture was 0%, 3.3%, 15.3%, 18.8%, and 28.6%, respectively. The risk factors for rupture were absence of hypertension, chronic heart failure, chronic-phase dissection, and Yale index. CONCLUSIONS: The risk of aortic rupture increased with an aortic diameter of ≥5.0 cm in patients with chronic aortic dissection in the descending or thoracoabdominal aorta. We would recommend 5.0 cm as an acceptable size for elective resection of subacute or chronic aortic dissection in the descending or thoracoabdominal aorta.
Authors: Michael L Williams; Madeleine de Boer; Bridget Hwang; Bruce Wilson; John Brookes; Nicholas McNamara; David H Tian; Timothy Shiraev; Ourania Preventza Journal: Ann Cardiothorac Surg Date: 2022-01
Authors: Kelly Jarvis; Judith T Pruijssen; Andre Y Son; Bradley D Allen; Gilles Soulat; Alireza Vali; Alex J Barker; Andrew W Hoel; Mark K Eskandari; S Chris Malaisrie; James C Carr; Jeremy D Collins; Michael Markl Journal: J Magn Reson Imaging Date: 2019-11-12 Impact factor: 4.813