Preliminary report on a sonographic method to determine the location of the intimal breach in Stanford type B aortic dissection.
Using a defined angle T, which can be measured noninvasively using Doppler ultrasound, we aim to determine the location of the intimal breach in Stanford type B aortic dissection (AD) and estimate the risk of AD using that measurement. Our subjects included 86 healthy volunteers, 60 hypertensive patients, and 42 patients with Stanford type B AD. We used dual functional color Doppler ultrasound to locate the central point of the high-speed flow zone within the descending aorta, and then calculated the angle T, using the law of cosines. In addition, we measured the degree of distortion within the descending aorta using Line BD, defined as the distance from the lateral edge of the left subclavian artery (LSA) to the center of the breach in the intima in AD. The value of T was approximately 24° ± 3° and was constant across all 3 groups. In addition, the increase in BD distance corresponded to increased distortion in the descending aorta between the LSA and the region of aortic artery ligament (RAALE). We found that when the preoperative BD was less than 2.6 cm, the aortic arch could be straightened, using a stent-graft, to approximate the normal aorta. When the preoperative BD is less than 2.6 cm, the aortic arch can be corrected using a stent. In addition, since the T angle is constant, we speculate that it can be used to predict the risk of intimal breach and estimate its location using digital subtraction angiography (DSA) to guide surgery.
Tang
Jingdong
J
Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. drtangjingdong@126.com
Wang
Yuqi
Y
Hang
Wenzhao
W
Fu
Weiguo
W
Jing
Zaiping
Z
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D015901:Angiography, Digital Subtraction; D001011:Aorta / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D015607:Stents; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult