Document Detail


Distribution of intimomedial tears in patients with type B aortic dissection.
MedLine Citation:
PMID:  20598476     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Thoracic endovascular aortic repair is a promising means of treating patients with complicated type B aortic dissection by excluding the intimomedial tears. This study aims to characterize the location of tears and to propose a classification of type B aortic dissections based on these findings.
METHODS: Advanced protocols in computed tomography scans of patients with type B aortic dissection were used to identify the size and location of intimomedial tears in relation to the origin of the left subclavian artery. Aortic imaging details in 72 un-operated patients were used as a reference standard. From 1999 to 2005, 44 patients underwent primary endovascular treatment for complications of type B aortic dissection.
RESULTS: Each patient had an average of 2.8 +/- 2.11 intimomedial tears. The median intimomedial tear surface area was 0.63 cm(2). The presence of >or=3 or >or=5 intimomedial tears in the descending thoracic aorta did not correlate with aortic branch malperfusion (P > .05). Thirteen of 26 (50%) patients with a tear >1.9 cm(2) had aortic branch malperfusion (P = .032). Ten of 14 (71%) patients with a tear >4.86 cm(2) (mean plus one standard deviation) had aortic branch malperfusion (P = .002). The location of tears ranged from -6 mm to +459.2 mm from the left subclavian artery orifice: 80.5% (n = 99) of these tears were above the reference origin of the celiac artery. Eight of 13 patients (62%) with a tear distal to 282 mm (the orifice of the celiac artery) had aortic branch malperfusion in (P = .04). A classification for the location of intimomedial tears is proposed with potential clinical relevance to endovascular repair: type 1 has no identifiable tears; type 2 has one or more tears with no tears distal to the orifice of the celiac artery; type 3 has tears involving the branch vessels of the abdominal aorta; and type 4 has intimomedial tears distal to the aortic bifurcation.
CONCLUSIONS: Characterization and location of intimomedial tears using computed tomography (CT) imaging is feasible and represents an important step in the management of type B aortic dissection. The location and surface area of tears is associated with malperfusion. Based on the proposed classification and anatomic reference data, three out of every four patients may have a favorable constellation of intimomedial tears (type 1 or 2) that would be amenable to endovascular repair and reverse aortic remodeling. The clinical correlation will be established in upcoming studies.
Authors:
Ali Khoynezhad; Irwin Walot; Matthew J Kruse; Tony Rapae; Carlos E Donayre; Rodney A White
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  52     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-06     Completed Date:  2010-09-27     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  562-8     Citation Subset:  IM    
Affiliation:
Division of Cardiothoracic Surgery, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA. akhoy@lycos.com
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Aged, 80 and over
Aneurysm, Dissecting / classification,  radiography*,  surgery
Aorta, Thoracic / radiography*,  surgery
Aortic Aneurysm, Thoracic / classification,  radiography*,  surgery
Aortic Rupture / classification,  radiography*,  surgery
Aortography / methods*
Blood Vessel Prosthesis Implantation
California
Chi-Square Distribution
Chronic Disease
Feasibility Studies
Female
Humans
Male
Middle Aged
Patient Selection
Predictive Value of Tests
Subclavian Artery / radiography
Tomography, X-Ray Computed*

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