Abstract
Objectives: Acute type B aortic dissection can have a stable course or evolve into aneurysm and subsequent adverse events. The aim of this systematic review was to analyze the morphologic predictors of an adverse course to establish their validity based on consistency of results. Methods: Fifty-one studies were included in this review, reporting on aortic size, false lumen (FL) size, primary entry tear (ET) size and location, status of FL thrombosis, number of ETs, branch vessels involvement, and FL longitudinal extent. Results: Some predictors showed good consistency, whereas others did not. Aortic size was the most investigated predictor. A larger diameter at presentation predicted worse outcomes, with few exceptions. Both FL size and size relative to true lumen size also predicted an adverse course, although a standardized measurement method was not used. Regarding primary ET size and location, evidence was sparse and somewhat conflicting. Although FL complete thrombosis was consistently associated with a more benign course, the role of partial thrombosis remained unclear and the concept of FL saccular formation might account for the inconsistency, but further evidence is needed. A higher number of re-entry tears was considered to be protective against false channel expansion, but results need to be confirmed. The predictive role of branch vessels involvement and FL longitudinal extent remain controversial. Conclusions: Among several predictors of aortic growth and events in acute type B aortic dissection, controversial and even conflicting results have been described. Consistent evidence has been demonstrated only for two predictors: aortic size at presentation is associated with adverse events and total FL thrombosis has a protective role.
| Original language | English |
|---|---|
| Pages (from-to) | 1925-1935.e8 |
| Journal | Journal of Vascular Surgery |
| Volume | 68 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Dec 1 2018 |
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Keywords
- Aortic diameter
- Complications
- Computed tomography (CT)
- Entry tear
- False lumen
- prognosis
ASJC Scopus subject areas
- Surgery
- Cardiology and Cardiovascular Medicine
Cite this
Current evidence in predictors of aortic growth and events in acute type B aortic dissection. / Spinelli, Domenico; Benedetto, Filippo; Donato, Rocco; Piffaretti, Gabriele; Marrocco-Trischitta, Massimiliano M.; Patel, Himanshu J.; Eagle, Kim A.; Trimarchi, Santi.
In: Journal of Vascular Surgery, Vol. 68, No. 6, 01.12.2018, p. 1925-1935.e8.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Current evidence in predictors of aortic growth and events in acute type B aortic dissection
AU - Spinelli, Domenico
AU - Benedetto, Filippo
AU - Donato, Rocco
AU - Piffaretti, Gabriele
AU - Marrocco-Trischitta, Massimiliano M.
AU - Patel, Himanshu J.
AU - Eagle, Kim A.
AU - Trimarchi, Santi
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Objectives: Acute type B aortic dissection can have a stable course or evolve into aneurysm and subsequent adverse events. The aim of this systematic review was to analyze the morphologic predictors of an adverse course to establish their validity based on consistency of results. Methods: Fifty-one studies were included in this review, reporting on aortic size, false lumen (FL) size, primary entry tear (ET) size and location, status of FL thrombosis, number of ETs, branch vessels involvement, and FL longitudinal extent. Results: Some predictors showed good consistency, whereas others did not. Aortic size was the most investigated predictor. A larger diameter at presentation predicted worse outcomes, with few exceptions. Both FL size and size relative to true lumen size also predicted an adverse course, although a standardized measurement method was not used. Regarding primary ET size and location, evidence was sparse and somewhat conflicting. Although FL complete thrombosis was consistently associated with a more benign course, the role of partial thrombosis remained unclear and the concept of FL saccular formation might account for the inconsistency, but further evidence is needed. A higher number of re-entry tears was considered to be protective against false channel expansion, but results need to be confirmed. The predictive role of branch vessels involvement and FL longitudinal extent remain controversial. Conclusions: Among several predictors of aortic growth and events in acute type B aortic dissection, controversial and even conflicting results have been described. Consistent evidence has been demonstrated only for two predictors: aortic size at presentation is associated with adverse events and total FL thrombosis has a protective role.
AB - Objectives: Acute type B aortic dissection can have a stable course or evolve into aneurysm and subsequent adverse events. The aim of this systematic review was to analyze the morphologic predictors of an adverse course to establish their validity based on consistency of results. Methods: Fifty-one studies were included in this review, reporting on aortic size, false lumen (FL) size, primary entry tear (ET) size and location, status of FL thrombosis, number of ETs, branch vessels involvement, and FL longitudinal extent. Results: Some predictors showed good consistency, whereas others did not. Aortic size was the most investigated predictor. A larger diameter at presentation predicted worse outcomes, with few exceptions. Both FL size and size relative to true lumen size also predicted an adverse course, although a standardized measurement method was not used. Regarding primary ET size and location, evidence was sparse and somewhat conflicting. Although FL complete thrombosis was consistently associated with a more benign course, the role of partial thrombosis remained unclear and the concept of FL saccular formation might account for the inconsistency, but further evidence is needed. A higher number of re-entry tears was considered to be protective against false channel expansion, but results need to be confirmed. The predictive role of branch vessels involvement and FL longitudinal extent remain controversial. Conclusions: Among several predictors of aortic growth and events in acute type B aortic dissection, controversial and even conflicting results have been described. Consistent evidence has been demonstrated only for two predictors: aortic size at presentation is associated with adverse events and total FL thrombosis has a protective role.
KW - Aortic diameter
KW - Complications
KW - Computed tomography (CT)
KW - Entry tear
KW - False lumen
KW - prognosis
UR - http://www.scopus.com/inward/record.url?scp=85051370233&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85051370233&partnerID=8YFLogxK
U2 - 10.1016/j.jvs.2018.05.232
DO - 10.1016/j.jvs.2018.05.232
M3 - Review article
VL - 68
SP - 1925-1935.e8
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
SN - 0741-5214
IS - 6
ER -