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(Circulation. 2004;110:II-256 – II-261.)
© 2004 American Heart Association, Inc.

Surgery for Aortic and Peripheral Vascular Disease

Growth Rate of Aortic Diameter in Patients With Type B Aortic Dissection During the Chronic Phase

Eijun Sueyoshi, MD; Ichiro Sakamoto, MD; Kuniaki Hayashi, MD; Tetsuji Yamaguchi, MD; Tatuya Imada, MD

From the Department of Radiology (E.S., I.S., K.H.), Nagasaki University School of Medicine, Nagasaki, Japan; and the Department of Radiology and Cardiovascular Surgery (E.S., T.Y., T.I.), Omura Municipal Hospital, Omura, Japan.

Correspondence to E. Sueyoshi, MD, Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501. E-mail EijunSueyoshi{at}aol.com

Background— The purpose of this study was to evaluate the growth rate of type B double-barrel aortic dissection with computed tomography (CT) and the factors influencing its enlargement.

Methods and Results— Sixty-two patients were entered into this study, and regular follow-up CT studies (mean; 49.1 months) were performed. The affected aortas and iliac arteries were divided into 5 segments (aortic arch, descending thoracic, suprarenal abdominal, infrarenal abdominal aorta, and iliac artery). Fifty-two of 62 patients (83.9%) had 1 or more segments increased in size during follow-up period. In a total of 177 segments, the presence or absence of blood flow in the false lumen and aortic diameter were evaluated on CT during the follow-up period. The factors (gender, diabetes mellitus, atherosclerotic disease, smoking, entry site in arch, initial diameter, chronic obstructive pulmonary disease, blood pressure, and age) influencing increase in the diameter and growth rate were also evaluated. Of 177 segments, 132 segments (74.6%) increased in size during the follow-up period. The presence of blood flow in the false lumen was the only significant risk factor for increase in the diameter in the univariate and multivariate analysis. The group with blood flow in the false lumen had a significantly higher mean growth rate (3.3 mm/year) than the group without blood flow (–1.4 mm/year) (P<0.0001). The growth rate of aortic dissections in thoracic aorta and abdominal aorta were 4.1 and 1.2 mm/year, respectively. There was a significant difference in the growth rate between the 2 groups (P=0.0003).

Conclusion— In type B aortic dissection, the affected aortas have shown a high incidence of enlargement during the follow-up period, and more careful follow-up study is needed for aortic dissections in the thoracic aorta. The presence of blood flow in the false lumen is the most important risk factor for aortic enlargement.

Key Words: aorta • aneurysm • risk factors • follow-up studies • tomography