Cao Long, Lu Weihang, Ge Yangyang, Wang Xinhao, He Yuan, Sun Guoyi, Liu Jie, Liu Xiaoping, Jia Xin, Xiong Jiang, Ma Xiaohui, Zhang Hongpeng, Wang Lijun, Guo Wei
Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
Department of General Surgery, Chinese PLA No. 983 Hospital, Tianjin, China.
Eur J Cardiothorac Surg. 2020 Oct 1;58(4):714-721. doi: 10.1093/ejcts/ezaa102.
This study aims to evaluate differences in proximal aorta geometry and identify specific anatomical predictors of type B aortic dissection (TBAD).
We evaluated computed tomographic angiograms of controls (n = 185) and patients with acute TBAD (n = 173). Using propensity score matching, we created 2 groups of 127 patients. 3mensio Vascular software was used to analyse the computed tomographic angiograms and measure the diameter, length, tortuosity index and angulation of the proximal aorta (divided into ascending aorta and aortic arch). Tortuosity index was calculated by dividing the centre lumen line length of the aortic segment by its shortest length. Angulation was measured by the centre lumen line 'tangent line angle'. Two independent multivariable models identified significant anatomical associations regarding the tortuosity and angulation geometry.
Aortic diameter and ascending aorta and aortic arch lengths in TBAD increased significantly. The aortic arch tortuosity was significantly higher in the TBAD group (P < 0.001), with no difference regarding the ascending aorta (P = 0.11). Ascending aorta and aortic arch angulation were significantly higher in the TBAD group (P = 0.01, P < 0.001, respectively). Multivariable analyses showed that increased aortic arch tortuosity and angulation were significant predictors of the development of TBAD [odds ratio (OR) 1.91, 95% confidence interval (CI) 1.40-2.59; P < 0.001 and OR 1.08, 95% CI 1.04-1.12; P < 0.001], respectively.
In addition to proximal aorta dilation and elongation, we identified increased aortic arch tortuosity and angulation as possible specific predictors of TBAD.
本研究旨在评估近端主动脉几何形态的差异，并确定B型主动脉夹层（TBAD）的特定解剖学预测因素。
我们评估了对照组（n = 185）和急性TBAD患者（n = 173）的计算机断层血管造影。使用倾向得分匹配，我们创建了两组各127例患者。使用3mensio血管软件分析计算机断层血管造影，并测量近端主动脉（分为升主动脉和主动脉弓）的直径、长度、迂曲指数和角度。迂曲指数通过将主动脉段的中心腔线长度除以其最短长度来计算。角度通过中心腔线“切线角”来测量。两个独立的多变量模型确定了与迂曲和角度几何形态相关的显著解剖学关联。
TBAD患者的主动脉直径、升主动脉和主动脉弓长度显著增加。TBAD组的主动脉弓迂曲度显著更高（P < 0.001），升主动脉迂曲度无差异（P = 0.11）。TBAD组的升主动脉和主动脉弓角度显著更高（分别为P = 0.01，P < 0.001）。多变量分析表明，主动脉弓迂曲度和角度增加是TBAD发生的显著预测因素[优势比（OR）1.91，95%置信区间（CI）1.40 - 2.59；P < 0.001和OR 1.08，95% CI 1.04 - 1.12；P < 0.001]。
除了近端主动脉扩张和伸长外，我们确定主动脉弓迂曲度和角度增加是TBAD可能的特定预测因素。
