Importance of false lumen thrombosis in type B aortic dissection prognosis

Santi Trimarchi, Jip L. Tolenaar, Frederik H W Jonker, Brian Murray, Thomas T. Tsai, Kim A. Eagle, Vincenzo Rampoldi, Hence J M Verhagen, Joost A. Van Herwaarden, Frans L. Moll, Bart E. Muhs, John A. Elefteriades

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Abstract

Background: Partial thrombosis of the false lumen has been reported as a significant predictor of mortality during follow-up in patients with acute type B aortic dissection. The purpose of this study was to investigate the correlation of false lumen thrombosis and aortic expansion during follow-up in patients with acute type B aortic dissection. Methods: All medically treated patients with acute type B aortic dissection observed in 4 cardiovascular referral centers between 1998 and 2011, with admission and follow-up computed tomography or magnetic resonance imaging scans, were included. Aortic diameters of the dissected aortas were measured at 4 levels on the baseline and follow-up scans, and annual growth rates were calculated. Univariate and multivariate regression analyses were used to investigate the effect of false lumen thrombosis on aortic growth rate. Results: A total of 84 patients were included, of whom 40 (47.6%) had a partially thrombosed false lumen, 7 (8.3%) had a completely thrombosed false lumen, and 37 (44.0%) had a patent false lumen. A total of 273 of the 336 (81.3%) evaluated aortic levels were dissected segments. Overall, the mean aortic diameter increased significantly at all evaluated levels (P <.001). Univariate analysis showed that annual aortic growth rates were significantly higher in those segments having a false lumen with partial thrombosis (mean, 4.25 ± 10.2) when compared with the patent group (mean, 2.10 ± 5.56; P = .035). In multivariate analysis, partial lumen thrombosis was an independent predictor of higher aortic growth (adjusted mean difference, 2.05 mm/year; 95% confidence interval, 0.10-4.01; P = .040). Conclusions: In patients with acute type B aortic dissection, aortic segments with a partially thrombosed false lumen have a significantly higher annual aortic growth rate when compared with those presenting with patent or complete thrombosis of the false lumen. Therefore, patients with partial thrombosis require more intensive follow-up and may benefit from prophylactic intervention.

Original languageEnglish
JournalJournal of Thoracic and Cardiovascular Surgery
Volume145
Issue number3 SUPPL.
DOIs
Publication statusPublished - Mar 2013

Fingerprint

Dissection
Thrombosis
Growth
Multivariate Analysis
Aorta
Referral and Consultation
Tomography
Regression Analysis
Magnetic Resonance Imaging
Confidence Intervals
Mortality

Keywords

  • ABAD
  • acute type B aortic dissection
  • International Registry of Acute Aortic Dissection
  • IRAD

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Trimarchi, S., Tolenaar, J. L., Jonker, F. H. W., Murray, B., Tsai, T. T., Eagle, K. A., ... Elefteriades, J. A. (2013). Importance of false lumen thrombosis in type B aortic dissection prognosis. Journal of Thoracic and Cardiovascular Surgery, 145(3 SUPPL.). https://doi.org/10.1016/j.jtcvs.2012.11.048

Importance of false lumen thrombosis in type B aortic dissection prognosis. / Trimarchi, Santi; Tolenaar, Jip L.; Jonker, Frederik H W; Murray, Brian; Tsai, Thomas T.; Eagle, Kim A.; Rampoldi, Vincenzo; Verhagen, Hence J M; Van Herwaarden, Joost A.; Moll, Frans L.; Muhs, Bart E.; Elefteriades, John A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 145, No. 3 SUPPL., 03.2013.

Research output: Contribution to journalArticle

Trimarchi, S, Tolenaar, JL, Jonker, FHW, Murray, B, Tsai, TT, Eagle, KA, Rampoldi, V, Verhagen, HJM, Van Herwaarden, JA, Moll, FL, Muhs, BE & Elefteriades, JA 2013, 'Importance of false lumen thrombosis in type B aortic dissection prognosis', Journal of Thoracic and Cardiovascular Surgery, vol. 145, no. 3 SUPPL.. https://doi.org/10.1016/j.jtcvs.2012.11.048
Trimarchi, Santi ; Tolenaar, Jip L. ; Jonker, Frederik H W ; Murray, Brian ; Tsai, Thomas T. ; Eagle, Kim A. ; Rampoldi, Vincenzo ; Verhagen, Hence J M ; Van Herwaarden, Joost A. ; Moll, Frans L. ; Muhs, Bart E. ; Elefteriades, John A. / Importance of false lumen thrombosis in type B aortic dissection prognosis. In: Journal of Thoracic and Cardiovascular Surgery. 2013 ; Vol. 145, No. 3 SUPPL.
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abstract = "Background: Partial thrombosis of the false lumen has been reported as a significant predictor of mortality during follow-up in patients with acute type B aortic dissection. The purpose of this study was to investigate the correlation of false lumen thrombosis and aortic expansion during follow-up in patients with acute type B aortic dissection. Methods: All medically treated patients with acute type B aortic dissection observed in 4 cardiovascular referral centers between 1998 and 2011, with admission and follow-up computed tomography or magnetic resonance imaging scans, were included. Aortic diameters of the dissected aortas were measured at 4 levels on the baseline and follow-up scans, and annual growth rates were calculated. Univariate and multivariate regression analyses were used to investigate the effect of false lumen thrombosis on aortic growth rate. Results: A total of 84 patients were included, of whom 40 (47.6{\%}) had a partially thrombosed false lumen, 7 (8.3{\%}) had a completely thrombosed false lumen, and 37 (44.0{\%}) had a patent false lumen. A total of 273 of the 336 (81.3{\%}) evaluated aortic levels were dissected segments. Overall, the mean aortic diameter increased significantly at all evaluated levels (P <.001). Univariate analysis showed that annual aortic growth rates were significantly higher in those segments having a false lumen with partial thrombosis (mean, 4.25 ± 10.2) when compared with the patent group (mean, 2.10 ± 5.56; P = .035). In multivariate analysis, partial lumen thrombosis was an independent predictor of higher aortic growth (adjusted mean difference, 2.05 mm/year; 95{\%} confidence interval, 0.10-4.01; P = .040). Conclusions: In patients with acute type B aortic dissection, aortic segments with a partially thrombosed false lumen have a significantly higher annual aortic growth rate when compared with those presenting with patent or complete thrombosis of the false lumen. Therefore, patients with partial thrombosis require more intensive follow-up and may benefit from prophylactic intervention.",
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AU - Eagle, Kim A.

AU - Rampoldi, Vincenzo

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