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Large distal tear of aortic dissection: Risk factor for postoperative distal aortic segmental enlargement
Lizhi Lv1, Yanqing Chen2, Yu Shen2, Zaiping Jing2, Yi Shi3, Simeng Zhang4, Qingsheng Lu2
1 Department of Pediatric Cardiac Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Shanghai, China
2 Department of Vascular, Changhai Hospital, Shanghai, India
3 Department of Cardiac Surgery, Peking University People's Hospital, Peking, China
4 Department of Vascular, Changhai Hospital, Shanghai; Department of Cardiac Surgery, Peking University People's Hospital, Peking, China
Correspondence Address:
Prof. Qingsheng Lu
Department of Vascular Surgery, Changhai Hospital, The First Affiliated Hospital of Navy Military Medical University, 168 Changhai Rd., Shanghai, 200433
India
Dr. Simeng Zhang
Department of Cardiac Surgery, Peking Universtiy People's Hospital, No. 11 Xizhimen South Rd., Xicheng District, Beijing, 100044
China
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2589-9686.377613
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BACKGROUND: The traditional treatment for aortic dissections (ADs) is a proximal repair of AD, but the long-term prognosis of residual distal dissection is unsatisfactory. The distal aortic intimal tear of distal aortic segmental enlargement (DASE) is evaluated via its size, with risk assessment, and assessed its risk, which will provide clinicians with diagnosis and treatment direction.
METHODS: We analyzed 419 ADs patients who underwent radiographic examination of the aorta between September 1999 and May 2014. We recorded the area of the aortic intimal tear and divided it into two groups (75 patients in DASE group and 344 patients in non-DASE group). Logistics regression analysis or natural logarithm transformation was used to explore the potential risk of remaining distal tears to DASE, while the Logistic multiple regress equations were used to find out the independent risk factors.
RESULTS: The postoperative large tear was defined as short diameter ≥5.0 mm. The independent risk factors of DASE are as follows: Short diameter of postoperative tears (odds ratios [ORs], 1.10;95% confidence interval [CI], 1.02–1.19; P < 0.0120); short diameter of the first tear after operation (OR, 1.12; 95% CI, 1.00–1.26; P < 0.0580) and the existence of large tears (OR, 1.13; 95% CI, 1.01–1.26; P < 0.0298).
CONCLUSIONS: Our findings suggest that the size of the remaining tears and the existence of large tears are the key risk factors for patients with DASE. Patients with large remaining tears should be supervised regularly and treated timely.
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