Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database
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Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database. / ADSORB Trialists; Kasprzak, Piotr; Brunkwall, Jan; Heijmen, Robin; Alric, Pierre; Verhoeven, Eric; Schumacher, Hardy; Fabiani, Jean Noel; Eckstein, Hans-Henning; Taylor, Peter; Mailina, Martin; Mangialardi, Nicola; Larzon, Thomas; Böckler, Dittmar; Lönn, Lars; Dialetto, Giovanni; Trimarchi, Santi; Lammer, Johannes.
In: Journal of Vascular Surgery, Vol. 65, No. 4, 04.2017, p. 964-971.e3.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database
AU - Kamman, Arnoud V
AU - Brunkwall, Jan
AU - Verhoeven, Eric L
AU - Heijmen, Robin H
AU - Trimarchi, Santi
AU - ADSORB Trialists
AU - Kasprzak, Piotr
AU - Brunkwall, Jan
AU - Heijmen, Robin
AU - Alric, Pierre
AU - Verhoeven, Eric
AU - Schumacher, Hardy
AU - Fabiani, Jean Noel
AU - Eckstein, Hans-Henning
AU - Taylor, Peter
AU - Mailina, Martin
AU - Mangialardi, Nicola
AU - Larzon, Thomas
AU - Böckler, Dittmar
AU - Lönn, Lars
AU - Dialetto, Giovanni
AU - Trimarchi, Santi
AU - Lammer, Johannes
N1 - Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
PY - 2017/4
Y1 - 2017/4
N2 - BACKGROUND: The high-risk patient cohort of uncomplicated type B aortic dissections (uTBADs) needs to be clarified. We compared uTBAD patients treated with best medical treatment (BMT), with and without aortic growth, from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) trial database. Furthermore, we looked for trends in outcome for aortic growth and remodeling after BMT and thoracic endovascular aortic repair (TEVAR) and BMT (TEVAR+BMT).METHODS: BMT patients with available baseline and a 1-year follow-up arterial computed tomography scan were identified. True lumen and false lumen diameter was assessed at baseline and at follow-up. Patients with false lumen growth (group I) and without false lumen growth (group II) were compared. Predictors of false lumen and total lumen (aortic) growth were identified. Lastly, BMT outcomes were compared with BMT+TEVAR for false lumen thrombosis and change in false lumen and total aortic diameter in four sections: 0 to 10 cm (A), 10 to 20 cm (B), 20 to 30 cm (C), and 30 to 40 cm (D) from the left subclavian artery.RESULTS: The dissection was significantly longer in group I than in group II (43.2 ± 4.9 cm vs 30.4 ± 8.8 cm; P = .002). The number of vessels originating from the false lumen at baseline was identified as an independent predictor of false lumen growth (odds ratio, 22.1; 95% confidence interval, 1.01-481.5; P = .049). Increasing age was a negative predictor of total aortic diameter growth (odds ratio, 0.902; 95% confidence interval, 0.813-1.00; P = .0502). The proximal sections A and B showed complete thrombosis in 80.6% in the BMT+TEVAR group compared with 9.5% in the BMT group. In these sections, changes from patent to partial or partial to complete thrombosis were observed in 90.3% of the TEVAR+BMT group vs 31.0% in the BMT group. In sections C and D, the change in thrombosis was 74.1% for the TEVAR+BMT group vs 20.6% for the BMT group. The false lumen diameter increase at section C was larger in the BMT group. Total lumen diameter decreased in sections A and B in the TEVAR+BMT group compared with an increase in the BMT group (-4.8 mm vs +2.9 mm, and -1.5 mm vs +3.8 mm, respectively). Sections C and D showed minimal and comparable expansion in both treatment groups.CONCLUSIONS: The new imaging analysis of the ADSORB trial patients identified the number of vessels originating from the false lumen as an independent predictor of false lumen growth in uTBAD patients. Increasing age was a negative predictor of aortic growth. Our analysis may help to identify which uTBAD patients are at higher risk and should receive TEVAR or be monitored closely during follow-up.
AB - BACKGROUND: The high-risk patient cohort of uncomplicated type B aortic dissections (uTBADs) needs to be clarified. We compared uTBAD patients treated with best medical treatment (BMT), with and without aortic growth, from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) trial database. Furthermore, we looked for trends in outcome for aortic growth and remodeling after BMT and thoracic endovascular aortic repair (TEVAR) and BMT (TEVAR+BMT).METHODS: BMT patients with available baseline and a 1-year follow-up arterial computed tomography scan were identified. True lumen and false lumen diameter was assessed at baseline and at follow-up. Patients with false lumen growth (group I) and without false lumen growth (group II) were compared. Predictors of false lumen and total lumen (aortic) growth were identified. Lastly, BMT outcomes were compared with BMT+TEVAR for false lumen thrombosis and change in false lumen and total aortic diameter in four sections: 0 to 10 cm (A), 10 to 20 cm (B), 20 to 30 cm (C), and 30 to 40 cm (D) from the left subclavian artery.RESULTS: The dissection was significantly longer in group I than in group II (43.2 ± 4.9 cm vs 30.4 ± 8.8 cm; P = .002). The number of vessels originating from the false lumen at baseline was identified as an independent predictor of false lumen growth (odds ratio, 22.1; 95% confidence interval, 1.01-481.5; P = .049). Increasing age was a negative predictor of total aortic diameter growth (odds ratio, 0.902; 95% confidence interval, 0.813-1.00; P = .0502). The proximal sections A and B showed complete thrombosis in 80.6% in the BMT+TEVAR group compared with 9.5% in the BMT group. In these sections, changes from patent to partial or partial to complete thrombosis were observed in 90.3% of the TEVAR+BMT group vs 31.0% in the BMT group. In sections C and D, the change in thrombosis was 74.1% for the TEVAR+BMT group vs 20.6% for the BMT group. The false lumen diameter increase at section C was larger in the BMT group. Total lumen diameter decreased in sections A and B in the TEVAR+BMT group compared with an increase in the BMT group (-4.8 mm vs +2.9 mm, and -1.5 mm vs +3.8 mm, respectively). Sections C and D showed minimal and comparable expansion in both treatment groups.CONCLUSIONS: The new imaging analysis of the ADSORB trial patients identified the number of vessels originating from the false lumen as an independent predictor of false lumen growth in uTBAD patients. Increasing age was a negative predictor of aortic growth. Our analysis may help to identify which uTBAD patients are at higher risk and should receive TEVAR or be monitored closely during follow-up.
KW - Adult
KW - Age Factors
KW - Aged
KW - Aorta, Thoracic/diagnostic imaging
KW - Aortic Aneurysm, Thoracic/diagnostic imaging
KW - Aortography/methods
KW - Blood Vessel Prosthesis
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Computed Tomography Angiography
KW - Databases, Factual
KW - Dilatation, Pathologic
KW - Disease Progression
KW - Endovascular Procedures/adverse effects
KW - Female
KW - Humans
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Odds Ratio
KW - Prosthesis Design
KW - Randomized Controlled Trials as Topic
KW - Retrospective Studies
KW - Risk Factors
KW - Stents
KW - Thrombosis/etiology
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.jvs.2016.09.033
DO - 10.1016/j.jvs.2016.09.033
M3 - Journal article
C2 - 27876516
VL - 65
SP - 964-971.e3
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
SN - 0741-5214
IS - 4
ER -
ID: 194910374