Predictors of hypoxemia in type-B acute aortic syndrome: a retrospective study

AbstractAcute aortic syndrome (AAS) can be life-threatening owing to a variety of complications, and it is managed in the intensive care unit (ICU). Although Stanford type-B AAS may involve hypoxemia, its predictors are not yet clearly understood. We studied clinical factors and imaging parameters for predicting hypoxemia after the onset of type-B AAS. We retrospectively analyzed patients diagnosed with type-B AAS in our hospital between January 2012 and April 2020. We defined hypoxemia as PaO2/FiO2 ≤ 200 within 7 days after AAS onset and used logistic regression analysis to evaluate prognostic factors for hypoxemia. We analyzed 224 consecutive patients (140 males, mean age 70 ± 14 years) from a total cohort of 267 patients. Among these, 53 (23.7%) had hypoxemia. The hypoxemia group had longer ICU and hospital stays compared with the non-hypoxemia group (median 20 vs. 16 days, respectively; p = 0.039 and median 7 vs. 5 days, respectively; p < 0.001). Male sex (odds ratio [OR] 2.87; 95% confidence interval [CI] 1.24–6.63; p = 0.014), obesity (OR 2.36; 95% CI 1.13–4.97; p = 0.023), patent false lumen (OR 2.33; 95% CI 1.09–4.99; p = 0.029), and high D-dimer level (OR 1.01; 95% CI 1.00–1.02; p = 0.047) were independently associated with hypoxemia by multivariate logistic analysis. This study showed a significant difference in duration of ICU and hospital stays between patients with and without hypoxemia. Furthermore, male sex, obesity, patent false lumen, and high D-dimer level may be significantly associated with hypoxemia in patients with type-B AAS.

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Aortic Intimal Tears: Detection with Spiral Computed Tomography

Journal of Endovascular Therapy ◽

10.1177/152660280301000315 ◽

2003 ◽

Vol 10 (3) ◽

pp. 505-510 ◽

Cited By ~ 23

Author(s):

Leslie E. Quint ◽

Joel F. Platt ◽

Seema S. Sonnad ◽

G. Michael Deeb ◽

David M. Williams

Keyword(s):

Computed Tomography ◽

Aortic Dissection ◽

False Lumen ◽

Type A ◽

Spiral Computed Tomography ◽

Type B ◽

Spiral Computed ◽

Significant Difference ◽

Single Detector ◽

Patent False Lumen

Purpose: To determine the frequency, locations, and sizes of aortic intimal tears detected using spiral computed tomography (CT). Methods: CT scans (26 single detector and 26 multidetector studies) from 52 patients with an unoperated aortic dissection and a patent false lumen were evaluated on a workstation. The number, location, and size of aortic tears were recorded and compared between the following groups: acute and chronic dissection, type A and type B, and single detector and multidetector studies. Results: In 52 patients, 129 tears were identified (mean 2.48 per patient, median 2, range 1–7). There were no significant differences in the number or size of tears between the acute and chronic, the type A and type B, or the single detector and multidetector groups (p<0.05). The most common locations for tears were the descending aorta (57, 44%) and the juxtarenal region (26, 20%). Within the type B category, there was no significant difference in tear locations between the acute and chronic groups (p>0.05). The majority of tears (88, 68%) were <1 cm in each dimension. Tears in the thoracic aorta were significantly larger than abdominal aortic tears (p<0.05). Conclusions: All patients with an aortic dissection and a patent false lumen demonstrated one or more aortic intimal tears using spiral CT. Although most tears were small (<1 cm), they were usually easily visualized.

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Chronic Type B Aortic Dissection Associated with Disseminated Intravascular Coagulopathy: The Risk of a Patent False Lumen in the Chronic Phase

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.40.210 ◽

2011 ◽

Vol 40 (4) ◽

pp. 210-214

Author(s):

Masato Sakamoto ◽

Manabu Hisahara

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Chronic Phase ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Disseminated Intravascular Coagulopathy ◽

Intravascular Coagulopathy ◽

Patent False Lumen

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Abstract 13675: Impact of Antithrombotic Therapy on Clinical Outcomes in Patients With Type B Acute Aortic Syndrome

Circulation ◽

10.1161/circ.142.suppl_3.13675 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Akiko Masumoto ◽

Shuichiro Kaji ◽

Yutaro Miyoshi ◽

Misun Pak ◽

Taiji Okada ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Adverse Events ◽

Antithrombotic Therapy ◽

Primary Outcome ◽

False Lumen ◽

Acute Aortic Syndrome ◽

Type B ◽

Artery Disease

Introduction: In type B acute aortic syndrome (B-AAS), degree of false lumen thrombosis is known to affect clinical outcome. Antithrombotic therapy might have impact on prognosis through affecting false lumen thrombosis.We aimed to assess the impact of antithrombotic therapy on clinical outcomes in patients with B-AAS. Methods: A total of 429 patients with acute B-AAS admitted to our hospital and discharged alive were retrospectively analyzed. The primary outcome was aorta-related adverse events, defined as a composite of aorta-related death, aortic rupture, surgical or endovascular aortic repair and progressive aortic dilation. Results: Of the 429 patients, 72 patients (17 %) were discharged with antithrombotic therapy and 357 (83 %) without antithrombotic therapy. 254 patients (59 %) presented with intramural hematoma with complete thrombosis of false lumen, and 175 (41 %) presented with classic aortic dissection. Reasons for prescription were coronary artery disease (n=25), cerebral ischemia (n=17) and others (n=30). In the antithrombotic group, patients were significantly older than no-antithrombotic group (73 ± 13 vs 67 ± 13 years, P= 0.001) and had more comorbidities such as dyslipidemia (40 % vs 26 %, P= 0.011), diabetes mellitus (22 % vs 11 %, P= 0.007) and coronary artery disease (36 % vs 5 %, P< 0.001). During a mean follow-up of 4.8 ± 5.2 years, 37 patients (51 %) in the antithrombotic group and 98 patients (27 %) in the no-antithrombotic group had a primary outcome event. Event-free survival rate among antithrombotic versus no-antithrombotic group was 36 % vs 73 % at 5 years (P< 0.001). Multivariate Cox regression analysis adjusted for age, sex, comorbidity and medication revealed that antithrombotic therapy was a significant risk factor for aorta-related adverse events (hazard ratio 2.08, 95% confidence interval 1.247-3.463; P= 0.005). Conclusion: In B-AAS, antithrombotic therapy was associated with an increased risk of aorta-related events. For patients with indispensable need of antithrombotic therapy, careful follow-up should be provided.

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Full PETTICOAT in acute type B aortic dissection with patent false lumen may offer positive remodeling for the distal aorta

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-020-01548-3 ◽

2020 ◽

Author(s):

Kenichi Hashizume ◽

Masanori Honda ◽

Mitsuharu Mori ◽

Toshiaki Yagami ◽

Hidenobu Takaki ◽

...

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

Patent False Lumen

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Postural change causing leg malperfusion resulting from expansion of a patent false lumen in type B aortic dissection

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2007.05.047 ◽

2007 ◽

Vol 134 (4) ◽

pp. 1046-1047 ◽

Cited By ~ 4

Author(s):

Atsushi Nakahira ◽

Hitoshi Ogino ◽

Hitoshi Matsuda ◽

Kenji Minatoya ◽

Hiroaki Sasaki ◽

...

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Type B ◽

Postural Change ◽

Type B Aortic Dissection ◽

Patent False Lumen

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Effects of the patent false lumen on the long-term outcome of type B acute aortic dissection☆

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2004.03.026 ◽

2004 ◽

Vol 26 (2) ◽

pp. 359-366 ◽

Cited By ~ 136

Author(s):

Koichi Akutsu ◽

Jun Nejima ◽

Kaname Kiuchi ◽

Kenji Sasaki ◽

Masami Ochi ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

False Lumen ◽

Type B ◽

Term Outcome ◽

Long Term Outcome ◽

Patent False Lumen

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Acute aortic syndrome: diagnostic strategy and clinical features

ESC CardioMed ◽

10.1093/med/9780198784906.003.0614 ◽

2018 ◽

pp. 2589-2591

Author(s):

Riccardo Gorla ◽

Eduardo Bossone ◽

Raimund Erbel

Keyword(s):

Aortic Dissection ◽

Predictive Value ◽

Acute Aortic Dissection ◽

False Lumen ◽

Diagnostic Strategy ◽

Intramural Haematoma ◽

Acute Aortic Syndrome ◽

Penetrating Aortic Ulcer ◽

Low Sensitivity ◽

D Dimer

Acute aortic syndrome (AAS) encompasses a constellation of life-threatening medical conditions including acute aortic dissection, intramural haematoma, and penetrating aortic ulcer; they are considered among the most lethal cardiovascular diseases due to their high short- and long-term mortality. Prompt diagnosis is fundamental to enhance survival, but is not always easy to achieve due to many atypical presentations of the diseases, and therefore requires a high index of suspicion. The 2014 European Society of Cardiology Guidelines proposed a novel diagnostic algorithm combining the aortic dissection detection (ADD) risk score (pretest probability of disease) with D-dimer assessment, chest X-ray, and aortic imaging (transthoracic echocardiography, computed tomography, and/or transoesophageal echocardiography). A ‘high-probability’ ADD score (score of 2–3) showed excellent specificity and positive predictive value for AAS, but low sensitivity; in these patients, expedited aortic imaging without D-dimer testing is mandatory in order to rapidly confirm the diagnosis and start treatment. Conversely, in patients with a ‘low-probability’ ADD score (score of 0–1), D-dimer assessment was found to safely and efficiently rule out AAS, with excellent sensitivity and negative predictive value. The usefulness of D-dimer testing for the diagnosis of intramural haematoma, penetrating aortic ulcer, and acute aortic dissection with a totally thrombosed false lumen needs further investigation.

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Toward the Best Treatment for Uncomplicated Patients With Type B Acute Aortic Dissection

Circulation ◽

10.1161/circ.100.suppl_2.ii-275 ◽

1999 ◽

Vol 100 (suppl_2) ◽

Author(s):

Akira Marui ◽

Takaaki Mochizuki ◽

Norimasa Mitsui ◽

Tadaaki Koyama ◽

Fumiko Kimura ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Phase ◽

Acute Aortic Dissection ◽

False Lumen ◽

Chronic Phase ◽

Aortic Diameter ◽

Type B ◽

Hypotensive Therapy ◽

Acute Dissection ◽

Patent False Lumen

Background —In the treatment of type B acute aortic dissection without complications, better results are obtained if surgery is performed before enlargement of the aorta in patients who are predicted to show aortic enlargement and if drug-based treatment is continued for patients who are predicted to show no enlargement. The purpose of this study was to predict the acute-phase factors that may affect chronic-phase aortic enlargement by studying chronic-phase enlargement of dissections in patients without complications during the acute phase. Methods and Results —In 101 patients with type B acute dissection who had no complications, univariate and multivariate factor analyses were performed to determine the predictors for chronic-phase enlargement (≥60 mm) of the dissected aorta. The independent predominant predictors for aortic enlargement in the chronic phase were a maximum aortic diameter of ≥40 mm and a patent false lumen during the acute phase. The values of actuarial freedom from aortic enlargement for the patients with a maximum aortic diameter of 40 mm and a patent false lumen at 1, 5, and 10 years were 43%, 33%, and 22%, respectively, whereas in patients with a maximum aortic diameter of <40 mm and a closed false lumen, the values were 97%, 94%, and 84%, respectively. Conclusions —These results suggest that patients with type B acute aortic dissection who show a maximum aortic diameter of ≥40 mm and a patent false lumen should undergo surgery earlier during the chronic phase before enlargement of aorta, whereas patients with a maximum aortic diameter of <40 mm and a closed false lumen should continue to receive hypotensive therapy.

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