Korean J Thorac Cardiovasc Surg.  2014 Feb;47(1):6-12.

Influence of Radiologically Evident Residual Intimal Tear on Expansion of Descending Aorta Following Surgery for Acute Type I Aortic Dissection

• Kim YS
• Kim JH
• Kim JB
• Yang DH
• Kang JW
• Hwang SK
• Choo SJ
• Chung CH

Abstract

BACKGROUND
Although a residual intimal tear may contribute to the dilatation of the descending aorta following surgical repair of acute type I aortic dissection (AD), its causal relationship has not been elucidated by clinical data due to the limited resolution of imaging modalities.
METHODS
This study enrolled 41 patients (age, 55.2+/-11.9 years) who were evaluated with dual-source computed tomography (CT) imaging of the whole aorta in the setting of the surgical repair of acute type I AD. Logistic regression models were used to determine the predictors of a composite of the aortic aneurysm formation (diameter >55 mm) and rapid aortic expansion (>5 mm/yr).
RESULTS
On initial CT, a distal re-entry tear was identified in 9 patients. Two patients failed to achieve proximal tear exclusion by the surgery. Serial follow-up CT evaluations (median, 24.6 months; range, 6.0 to 67.2 months) revealed that 14 patients showed rapid expansion of the descending aorta or aortic aneurysm formation. A multivariate analysis revealed that the residual intimal tear (odds ratio [OR], 4.31; 95% confidence interval [CI], 1.02 to 19.31) and the patent false lumen in the early postoperative setting (OR, 4.64; 95% CI, 0.99 to 43.61) were predictive of the composite endpoint.
CONCLUSION
The presence of a residual intimal tear following surgery for acute type I AD adversely influenced the expansion of the descending aorta.

Keyword

Aortic dissection; Aneurysm; Surgery; Risk analysis

MeSH Terms

Aneurysm
Aorta
Aorta, Thoracic*
Aortic Aneurysm
Dilatation
Follow-Up Studies
Humans
Logistic Models
Multivariate Analysis