title: Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy.
abstract: BACKGROUND
  Proximal aortic dissections are life-threatening conditions that require immediate surgical intervention to avert an untreated mortality rate that approaches 50% at 48 hours. Advances in computed tomography (CT) imaging techniques have permitted increased characterization of aortic dissection that are necessary to assess the design and applicability of new treatment paradigms.
  
  
  METHODS
  All patients presenting during a 2-year period with acute proximal aortic dissections who underwent CT scanning were reviewed in an effort to establish a detailed assessment of their aortic anatomy. Imaging studies were assessed in an effort to document the location of the primary proximal fenestration, the proximal and distal extent of the dissection, and numerous morphologic measurements pertaining to the aortic valve, root, and ascending aorta to determine the potential for an endovascular exclusion of the ascending aorta.
  
  
  RESULTS
  During the study period, 162 patients presented with proximal aortic dissections. Digital high-resolution preoperative CT imaging was performed on 76 patients, and 59 scans (77%) were of adequate quality to allow assessment of anatomic suitability for treatment with an endograft. In all cases, the dissection plane was detectable, yet the primary intimal fenestration was identified in only 41% of the studies. Scans showed 24 patients (32%) appeared to be anatomically amenable to such a repair (absence of valvular involvement, appropriate length and diameter of proximal sealing regions, lack of need to occlude coronary vasculature). Of the 42 scans that were determined not to be favorable for endovascular repair, the most common exclusion finding was the absence of a proximal landing zone (n = 15; 36%).
  
  
  CONCLUSIONS
  Appropriately protocoled CT imaging provides detailed anatomic information about the aortic root and ascending aorta, allowing the assessment of which dissections have proximal fenestrations that may be amenable to an endovascular repair.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Moon
authors.forename: Roy K
authors.initials: RK
authors.lastname: Greenberg
authors.forename: Jose P
authors.initials: JP
authors.lastname: Morales
authors.forename: Zenia
authors.initials: Z
authors.lastname: Martin
authors.forename: Qingsheng
authors.initials: Q
authors.lastname: Lu
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Dowdall
authors.forename: Adrian V
authors.initials: AV
authors.lastname: Hernandez
mesh_terms: D000368:Aged; D000465:Algorithms; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000601:surgery; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D001027:Aortography / Q000379:methods*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D057510:Endovascular Procedures / Q000295:instrumentation; D006801:Humans; D008875:Middle Aged; D009820:Ohio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011857:Radiographic Image Interpretation, Computer-Assisted; D015607:Stents; D014057:Tomography, X-Ray Computed