Adel Mohammed Amer Al-Kalei1, Ziheng Wu1, Hongkun Zhang2. 1. Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qinqchun Road, Hangzhou 310003, Zhejiang, China. 2. Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qinqchun Road, Hangzhou 310003, Zhejiang, China. Electronic address: 1198050@zju.edu.cn.
Abstract
PURPOSE: To investigate the effect of a primary intimal tear's position on the distal convexity as a factor predisposing patients to developing a retrograde type A aortic dissection (RTAAD) after endovascular repair for type B aortic dissections. MATERIALS AND METHODS: From January 2010 to December 2015, 334 patients with type B aortic dissections identified from a retrospective thoracic endovascular repair database were assigned to 2 groups based on the location of primary intimal tears in the distal aortic arch. Other potential risk factors were analyzed, and Kaplan-Meier survival curves were constructed. RESULTS: The location of the primary intimal tear was identified in 230 patients (68.9%) in the convexity group and in 104 patients (31.1%) in the concavity group. After intervention, 20 patients (convexity: 7.8%, concavity: 1.9%) developed an RTAAD. Univariate analysis identified that the location of the primary intimal tears (P = .053), the areas involved by dissection (P = < .001), and the covering of the brachiocephalic trunk (P = .024) were significantly associated with RTAAD. Multivariate analysis revealed that a primary entry tear at the distal convexity might be a predictor for developing RTAAD (P = .053), with a relative risk of 4.243 (95% confidence interval, 0.984-18.286). CONCLUSIONS: Patients with primary intimal tears located in the distal convexity may be more likely to develop RTAAD than patients with primary intimal tears in the distal concavity.
PURPOSE: To investigate the effect of a primary intimal tear's position on the distal convexity as a factor predisposing patients to developing a retrograde type A aortic dissection (RTAAD) after endovascular repair for type B aortic dissections. MATERIALS AND METHODS: From January 2010 to December 2015, 334 patients with type B aortic dissections identified from a retrospective thoracic endovascular repair database were assigned to 2 groups based on the location of primary intimal tears in the distal aortic arch. Other potential risk factors were analyzed, and Kaplan-Meier survival curves were constructed. RESULTS: The location of the primary intimal tear was identified in 230 patients (68.9%) in the convexity group and in 104 patients (31.1%) in the concavity group. After intervention, 20 patients (convexity: 7.8%, concavity: 1.9%) developed an RTAAD. Univariate analysis identified that the location of the primary intimal tears (P = .053), the areas involved by dissection (P = < .001), and the covering of the brachiocephalic trunk (P = .024) were significantly associated with RTAAD. Multivariate analysis revealed that a primary entry tear at the distal convexity might be a predictor for developing RTAAD (P = .053), with a relative risk of 4.243 (95% confidence interval, 0.984-18.286). CONCLUSIONS:Patients with primary intimal tears located in the distal convexity may be more likely to develop RTAAD than patients with primary intimal tears in the distal concavity.