Increased Ascending Aortic Length Might be Associated with Increased Risk for Retrograde Type A Dissection After TEVAR
Halim Yammine, Stephen J Arko, Tre D Thorne, Charles S Briggs, Gregory A Stanley, Jeko Madjarov, John R Frederick, Frank R Arko, III
Sanger Heart and Vascular institute, Charlotte, NC
INTRODUCTION: Studies have shown an association between ascending aortic length (AAL) and adverse aortic events mainly in patients with ascending aortic aneurysms. We aim to evaluate the relationship between ascending aortic length and the risk of retrograde type A dissection (RTAD) after TEVAR for type B aortic dissection (TBAD). METHODS: Between January 2012 and January 2017, 186 patients underwent TEVAR for TBAD at a multidisciplinary aortic center. Patients with history of ascending aortic repairs prior to the TEVAR and patients in whom CT images could not be found were eliminated (28 patients). RESULTS: There were 13 patients in the RTAD group and 145 patients in the no-RTAD group (N=158). The average ascending aortic length (AAL) in the RTAD group was 67.6 mm (SD 33.5) compared with 65.9 mm (SD 33.3) in the no-RTAD group (p=0.15). The median AAL for the entire cohort was 65.1 mm. 9/13 (69.2%) patients in the RTAD group had an AAL longer than the median (65.1 mm) compared to only 67/145 (46%) in the no-RTAD group, approaching statistical significance (p=0.06). The ascending aortic angle (AAg) was also evaluated and compared between the two groups. The average angle in the RTAD group was 143.2 deg (SD 57.9) compared to 140.9 deg (SD 52.7) in the no-RTAD group (p=0.14). The median angle for the whole cohort was 141 deg. 8/13 (61%) of RTAD patients had an AAg greater than the median compared to 68/145 (47%) in the no-RTAD group (p=0.3). CONCLUSIONS: An AAL longer than 65.1 mm was found in more than 69% of patients who developed RTAD after TEVAR for TBAD compared to only 46% in patients who did not develop RTAD. The difference approached statistical significance suggesting a possible correlation between AAL and increased risk for RTAD in this patient population. We suggest adding AAL > 6.5cm to the list of already identified anatomical findings associated with increased risk of RTAD after TEVAR. Studies with larger sample size are needed to further delineate this correlation.
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