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Referral and Imaging Surveillance Patterns for Uncomplicated Type B Aortic Dissection at a Tertiary Referral Center
Griffin P Stinson, Jonathan R Krebs, Liam Kugler, Chelsea Viscardi, Brian Fazzone, Martin Back, Salvatore Scali, Samir Shah, Gilbert Upchurch, Michol Cooper
University of Florida, Gainesville, FL

INTRODUCTION: Acute and subacute uncomplicated type B aortic dissections (auTBAD) are managed with medical treatment or with endovascular therapy. Based on the best available data, auTBAD with low-risk imaging characteristics are managed with anti-impulse therapy and long-term imaging surveillance with intervention if progression is identified. However, those who fail to adhere to surveillance regimens are at increased risk of delayed presentation with acute aortic syndromes and have higher long-term mortality. We sought to identify patterns of referral and imaging surveillance in our practice.
METHODS: In this single-center, retrospective cohort study, demographics, follow-up, and outcomes of patients with auTBAD from 8/2011-11/2021 were analyzed. Imaging surveillance (IS) was defined as aorta-directed surveillance imaging with associated in-person/telephone encounter at our institution &ge3 months from index hospitalization. Univariate analysis was used to compare patients with and without IS. Those with No IS were presumed lost to follow-up or had planned to undergo local surveillance. Home region was defined by geographic position of patient home address within the state of Florida, either panhandle, north, central, south, or out of state.
RESULTS: A total of 161 auTBAD patients managed medically were identified. Seventy (43%) patients underwent IS for a median of 16 (IQR 25) months. There were no differences in age, sex, race, insurance status, or smoking status. Median patient home address was 96.1 miles from our center, with no difference between IS (85.7 IQR 86.4) versus No IS(104.9 IQR 91.5) groups (p=0.29), and no difference in regional distribution of home address. Prior cardiovascular surgery (20% vs 6%, p=0.01) and diabetes (15% vs 6%, p=0.05) were more common in those with No IS. Most patients (95%) presented as hospital transfers, with no difference between IS (91%) and No IS (98%) (p=0.06). Patients with IS were more likely to be discharged home (93% vs 71%, p&lt0.01). Post-discharge TEVAR occurred in 23% of patients and was more common in the IS group (26% vs 4%, p&lt0.01). In TEVAR patients, there was no difference between the rate of urgent/emergent intervention between IS (22%) No IS (50%) (p=0.30), and no difference in the median time to TEVAR between IS (350 IQR 649.5 days) No IS(481.5 IQR 1229.25 days) (p=0.61).
CONCLUSIONS: Overall adherence to auTBAD imaging surveillance was low and did not vary by patient demographics or home region. This highlights the difficulties in tertiary center care coordination when patients travel far from home and particularly in patients who are discharged to non-home facilities. Further work is needed to identify obstacles to imaging surveillance following auTBAD admission.
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