[en] [en] BACKGROUND: Improved risk stratification is a key priority for type B aortic dissection (TBAD). Partial false lumen thrombus morphology is an emerging predictor of complications. However, partial thrombosis is poorly defined, and its evaluation in clinical studies has been inconsistent. Thus, we aimed to characterize the hemodynamic pressure in TBAD and determine how the pressure relates to the false lumen thrombus morphology and clinical events.
METHODS: The retrospective admission computed tomography angiograms of 69 patients with acute TBAD were used to construct three-dimensional computational models for simulation of cyclical blood flow and calculation of pressure. The patients were categorized by the false lumen thrombus morphology as minimal, extensive, proximal or distal thrombosis. Linear regression analysis was used to compare the luminal pressure difference between the true and false lumen for each morphology group. The effect of morphology classification on the incidence of acute complications within 14 days was studied using logistic regression adjusted for clinical parameters. A survival analysis for adverse aortic events at 1 year was also performed using Cox regression.
RESULTS: Of the 69 patients, 44 had experienced acute complications and 45 had had an adverse aortic event at 1 year. The mean ± standard deviation age was 62.6 ± 12.6 years, and 75.4% were men. Compared with the patients with minimal thrombosis, those with proximal thrombosis had a reduced false lumen pressure by 10.1 mm Hg (95% confidence interval [CI], 4.3-15.9 mm Hg; P = .001). The patients who had not experienced an acute complication had had a reduced relative false lumen pressure (-6.35 mm Hg vs -0.62 mm Hg; P = .03). Proximal thrombosis was associated with fewer acute complications (odds ratio, 0.17; 95% CI, 0.04-0.60; P = .01) and 1-year adverse aortic events (hazard ratio, 0.36; 95% CI, 0.16-0.80; P = .01).
CONCLUSIONS: We found that proximal false lumen thrombosis was a marker of reduced false lumen pressure. This might explain how proximal false lumen thrombosis appears to be protective of acute complications (eg, refractory hypertension or pain, aortic rupture, visceral or limb malperfusion, acute expansion) and adverse aortic events within the first year.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Parker, Louis P; Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, UWA Centre for Medical Research, The University of Western Australia, Perth, Western Australia, School of Engineering, The University of Western Australia, Perth, Western Australia
Reutersberg, Benedikt; Department for Vascular and Endovascular Surgery, Munich Aortic Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany, Department for Vascular Surgery, University Hospital of Zurich, Zurich, Switzerland
Syed, Maaz B J; Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
Munshi, Bijit; Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, UWA Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Medical School, The University of Western Australia, Perth, Western Australia
Richards, Samantha; Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, UWA Centre for Medical Research, The University of Western Australia, Perth, Western Australia, School of Engineering, The University of Western Australia, Perth, Western Australia
Kelsey, Lachlan J; Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, UWA Centre for Medical Research, The University of Western Australia, Perth, Western Australia, School of Engineering, The University of Western Australia, Perth, Western Australia
Sakalihasan, Natzi ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie cardio-vasculaire et thoracique
Eckstein, Hans-Henning; Department for Vascular and Endovascular Surgery, Munich Aortic Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Norman, Paul E; Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, UWA Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Medical School, The University of Western Australia, Perth, Western Australia
Doyle, Barry J; Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, UWA Centre for Medical Research, The University of Western Australia, Perth, Western Australia, School of Engineering, The University of Western Australia, Perth, Western Australia, Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom, Australian Research Council Centre for Personalised Therapeutics Technologies, Australian Capital Territory, Australia. Electronic address: barry.doyle@uwa.edu.au
Language :
English
Title :
Proximal false lumen thrombosis is associated with low false lumen pressure and fewer complications in type B aortic dissection.
Australian Government Government of Western Australia
Funding text :
The authors would like to acknowledge funding support from the National Health and Medical Research Council (grant APP1083572), the Australia and New Zealand Society for Vascular Surgery (ANZSVS) Vascular Foundation and the Pawsey Supercomputing Centre with funding from the Australian Government and the Government of Western Australia. Throughout this project Louis P. Parker was supported by the William and Marlene Schrader Trust.
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