DiMusto Paul D, Rademacher Brooks L, Philip Jennifer L, Akhter Shahab A, Goodavish Christopher B, De Oliveira Nilto C, Tang Paul C
Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Division of General Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
J Surg Res. 2017 Jun 1;213:39-45. doi: 10.1016/j.jss.2017.02.034. Epub 2017 Feb 27.
This study compares the morphology and outcomes of acute retrograde type A dissections (RTADs) with acute antegrade type A dissections (ATADs), and acute type B dissections.
From 2000 to 2016, there were 12 acute RTADs, 96 ATADs, and 92 type B dissections with available imaging. Dissections were characterized using computerized tomography angiography images. We examined clinical features, tear characteristics, and various morphologic measurements.
Compared with acute type B dissections, RTAD primary tears were more common in the distal arch (75% versus 43%, P = 0.04), and the false-to-true lumen contrast intensity ratio at the mid-descending thoracic aorta was lower (0.46 versus 0.71, P = 0.020). RTAD had less false lumen decompression because there were fewer aortic branch vessels distal to the subclavian that were perfused through the false lumen (0.40 versus 2.19, P < 0.001). Compared with ATAD, RTAD had less root involvement where root true-to-total lumen area ratio was higher (0.88 versus 0.76, P = 0.081). Furthermore, RTAD had a lower false-to-true lumen contrast intensity ratio at the root (0.25 versus 0.57, P < 0.05), ascending aorta (0.25 versus 0.72, P < 0.001), and proximal arch (0.39 versus 0.67, P < 0.05). RTAD were more likely to undergo aortic valve resuspension (100% versus 74%, P = 0.044).
RTAD tends to occur when primary tears occur in close proximity to the aortic arch and when false lumen decompression through the distal aortic branches are less effective. Compared with ATAD, RTAD has less root involvement, and successful aortic valve resuspension is more likely.
本研究比较急性逆行性A型主动脉夹层（RTAD）与急性顺行性A型主动脉夹层（ATAD）及急性B型主动脉夹层的形态学和预后。
2000年至2016年期间，有12例急性RTAD、96例ATAD及92例B型主动脉夹层有可用影像学资料。利用计算机断层血管造影图像对夹层进行特征分析。我们检查了临床特征、破口特征及各种形态学测量指标。
与急性B型主动脉夹层相比，RTAD的原发破口在主动脉弓远端更常见（75%对43%，P = 0.04），胸降主动脉中段假腔与真腔的对比强度比值更低（0.46对0.71，P = 0.020）。RTAD的假腔减压较少，因为锁骨下动脉远端通过假腔供血的主动脉分支较少（0.40对2.19，P < 0.001）。与ATAD相比，RTAD的根部受累较少，根部真腔与总腔面积比值更高（0.88对0.76，P = 0.081）。此外，RTAD在根部（0.25对0.57，P < 0.05）、升主动脉（0.25对0.72，P < 0.001）及主动脉弓近端（0.39对0.67，P < 0.05）的假腔与真腔对比强度比值更低。RTAD更有可能进行主动脉瓣重新悬吊（100%对74%，P = 0.044）。
当原发破口靠近主动脉弓且通过主动脉远端分支的假腔减压效果较差时，倾向于发生RTAD。与ATAD相比，RTAD的根部受累较少，且更有可能成功进行主动脉瓣重新悬吊。
