Nomogram to Predict Delayed Complications in Patients with Uncomplicated Acute Type B Aortic Dissection

Abstract Background Delayed complications within the first 2 weeks in initially uncomplicated acute type B aortic dissection (uATBAD) are not scarce, which needs special attention to prevent potentially fatal complications. This study aims to develop a nomogram for estimating the probability of patients with uATBAD developing delayed complications. Methods The nomogram was derived from a retrospectively study of 135 patients with uATBAD from 2011 to 2021 at a single medical center. The performance of the nomogram was evaluated from discrimination, calibration, and clinical usefulness. The results were internally validated by bootstrapping. Results In the multivariate analysis, the independent predictors of delayed complications identified were age ≥65 years (OR, 0.320; 95%CI, 0.108-0.831; P = 0.027), C-reactive protein (OR, 1.017; 95%CI, 1.006-1.029; P = 0.003), and maximum diameter of primary entry tear (OR, 1.089; 95%CI, 1.025-1.162; P = 0.007). The prediction model was internally validated by bootstrapping and revealed good discrimination (optimism-corrected C statistic, 0.706) and good calibration (Hosmer–Lemeshow test, P = 0.6468). Decision curve analysis demonstrated that the prediction nomogram was clinically useful. Conclusions This study presents a nomogram based on independent predictors of clinical and morphological parameters that could help identify patients with uATBAD who might occur delayed complications and thus improve the prognosis of patients.

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Outcome of Medical and Surgical Treatment in Patients With Acute Type B Aortic Dissection

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70471-8 ◽

2007 ◽

Vol 2007 ◽

pp. 169-170

Author(s):

G.L. Moneta

Keyword(s):

Surgical Treatment ◽

Aortic Dissection ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection

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A new mechanism why an acute type B aortic dissection is primary complicated, becomes complicated or remains uncomplicated

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269218 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

M Czerny ◽

C Loewe ◽

G Sodeck ◽

J Ta ◽

M Schoder ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection

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Surgical treatment of acute type B aortic dissection associated with use of cocaine

Orvosi Hetilap ◽

10.1556/oh.2009.28541 ◽

2009 ◽

Vol 150 (3) ◽

pp. 129-131 ◽

Cited By ~ 1

Author(s):

Zoltán Szeberin ◽

Gábor Firneisz ◽

Gábor Bíró ◽

Gábor Viktor Szabó ◽

Péter Sótonyi ◽

...

Keyword(s):

Surgical Treatment ◽

Aortic Dissection ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection

A kokainfogyasztás gyakorisága Magyarországon is növekszik. E drog használata fokozott kockázatot jelent szív- és érrendszeri betegségek kialakulása, például aortadissectio szempontjából. Klinikánkon zajlik hazánkban a B típusú aortadissectiós betegek döntő többségének ellátása. Célkitűzés: Egy rendszeresen kokaint használó, akut B típusú aortadissectiót elszenvedett beteg műtéti kezelését mutatjuk be esetismertetésünkben, amely tudomásunk szerint az első hasonló eset hazánkban. Módszer: Esetleírás. Eredmények: Egy 35 éves férfi erős, mellkasi-háti-deréktáji fájdalmak miatt először a gerincsebészeti osztályhoz fordult, majd kiugróan magas vérnyomásértékek miatt belgyógyászati osztályra helyezték át. A B típusú aortadissectio diagnózisát CT-angiographia igazolta, a beteg érsebészeti centrumba került, ahol sikeres műtétet, thoracoabdominalis aortarefenesztrációt végeztünk. A beteg 3 hónappal a műtét után jól van, antihipertenzív szerek szedése mellett mindennapi feladatait ellátja, szövődményt nem észleltünk, a kokainról leszokott. Következtetések: Az akut B típusú dissectio sebészi ellátása megmentheti a beteg életét. A hosszú távú eredményes kezelésben a hipertónia kontrollja mellett a kokainról történő leszokás alapvető jelentőségű. Hasonló esetek előfordulására a kokainfogyasztás növekedése esetén hazánkban is számíthatunk.

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Acute type B aortic dissection extending into arteria lusoria - unexpected challenge of endovascular treatment with chimney technique: case report

10.26226/morressier.5f1190be6aad87543c854f85 ◽

2020 ◽

Author(s):

Gloria Adam ◽

Ivo Petrov ◽

Zoran Stankov ◽

Metodi Mihailov

Keyword(s):

Case Report ◽

Aortic Dissection ◽

Endovascular Treatment ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

Chimney Technique ◽

Arteria Lusoria

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Endovascular Therapy for Nonischemic vs Ischemic Complicated Acute Type B Aortic Dissection

Journal of Endovascular Therapy ◽

10.1177/1526602819888672 ◽

2019 ◽

Vol 27 (1) ◽

pp. 145-152 ◽

Cited By ~ 2

Author(s):

Ahmed Eleshra ◽

Tilo Kölbel ◽

Giuseppe Panuccio ◽

Fiona Rohlffs ◽

E. Sebastian Debus ◽

...

Keyword(s):

Aortic Dissection ◽

Uncontrolled Hypertension ◽

Aortic Dilatation ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

Ischemic Group ◽

Atherosclerotic Stenosis ◽

Significant Difference ◽

Branch Vessel

Purpose: To report a single-center experience with thoracic endovascular aortic repair (TEVAR) for complicated acute type B aortic dissection (cATBAD) comparing patients with vs without end-organ ischemia. Materials and Methods: Between November 2010 and December 2017, 64 patients (mean age 64.8±12.5 years; 49 men) underwent TEVAR for cATBAD. Patients were grouped into 2 cohorts: nonischemic (39, 61%) patients with unrelenting pain, early progressive aortic dilatation, uncontrolled hypertension, or rupture, and ischemic (25, 39%) patients with visceral, renal, lower extremity, or spinal cord hypoperfusion. Results: Mean time from diagnosis to treatment was 7.5 days (range 1–32) in the nonischemic group vs 2.3 days (range 1–14) days in the ischemic group (p=0.007). Fourteen (56%) of 25 ischemic cATBAD patients had stents implanted in the renovascular branch vessels, while 4 (16%) patients had stents implanted in the iliac arteries. When branch vessel cannulation failed, fenestrations were made in the intimal flap to improve perfusion of the involved branch (n=5). In the nonischemic group, 3 arteries were stented owing to atherosclerotic stenosis. Technical success was achieved in 62 (97%) of 64 patients; despite stenting, 2 patients had low renal artery perfusion on final angiography. There were no statistically significant differences in early or late outcomes between the nonischemic vs ischemic cATBAD patients. Six (9%) patients died within 30 days: 2 (5%) in the nonischemic group vs 4 (16%) in the ischemic group. Major complications (1 stroke, 2 cases of paraplegia, 1 retrograde type A dissection, and 1 case of bowel ischemia) occurred only in the nonischemic group. The mean follow-up was 28 months. Late endoleaks were observed in 3 (8%) nonischemic patients and 1 (4%) ischemic patient. Reinterventions were required in 7 (18%) nonischemic patients and 4 (16%) ischemic patients. Conclusion: TEVAR is an effective and safe method of treating cATBAD. Early intervention in ischemic cATBAD may have played a significant role in the lack of significant difference between ischemic and nonischemic cATBAD outcomes. Direct visceral reperfusion through branch vessel stenting during TEVAR may be crucial in achieving good outcomes in ischemic cATBAD.

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