The dissected aorta: part III. Anatomy and radiologic diagnosis of branch-vessel compromise.
OBJECTIVE
To determine the anatomic, hemodynamic, and radiologic characteristics of branch-vessel compromise in patients with aortic dissection.


METHODS
Sixty-two patients with aortic dissection were evaluated with aortography (n = 62), intravascular ultrasound (US) (n = 35), and manometry (n = 56). Branch-vessel compromise with ischemia was suspected in 40 of these patients. Radiologic and manometric findings were correlated with clinical findings of ischemia. Femoral artery pulse strength was correlated with access from the respective femoral artery to the true and false lumina of the dissected aorta.


RESULTS
Twenty-six of 40 patients suspected of having ischemia had angiographic evidence of branch-vessel compromise, and intravascular US helped identify two types of branch-vessel compromise in them: static (dissection intersected and narrowed the vessel origin) and dynamic (dissection spared the vessel origin, but the dissection flap appeared to compress the true lumen at or above the origin and covered the origin). False-lumen pressure in classic dissections exceeded (n = 16) or equaled (n = 30) true-lumen pressure. Branch vessels that arose exclusively from the false lumen were well perfused. Findings of a dissection flap oriented concave toward the false lumen were 91% sensitive and 72% specific for a true-lumen pressure deficit.


CONCLUSIONS
Intravascular US and manometric findings clarify the mechanisms of branch-vessel compromise after aortic dissection and provide a rational guide for percutaneous treatment.
Williams
D M
DM
Department of Radiology, University of Michigan, Ann Arbor 48109-0030, USA.
Lee
D Y
DY
Hamilton
B H
BH
Marx
M V
MV
Narasimham
D L
DL
Kazanjian
S N
SN
Prince
M R
MR
Andrews
J C
JC
Cho
K J
KJ
Deeb
G M
GM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001027:Aortography; D006801:Humans; D007511:Ischemia / Q000209:etiology; D008365:Manometry; D008875:Middle Aged; D018084:Ultrasonography, Interventional