title: The location of the primary entry tear in acute type B aortic dissection affects early outcome.
abstract: OBJECTIVE
  The goal of the retrospective study was to relate the site of the primary entry tear in acute type B aortic dissections to the presence or development of complications.
  
  
  METHODS
  A consecutive series of 52 patients referred with acute type B aortic dissection was analysed with regard to the location of the primary entry tear (convexity or concavity of the distal aortic arch) using the referral CT scans at the time of diagnosis. These findings were related to the clinical outcome as well as to the need for intervention.
  
  
  RESULTS
  Twenty-five patients (48%) had the primary entry tear located at the convexity of the distal aortic arch, whereas 27 patients (52%) had the primary entry tear located at the concavity of the distal aortic arch. Twenty per cent of patients with the primary entry tear at the convexity presented with or developed complications, whereas 89% had or developed complications with the primary entry tear at the concavity (P < 0.001). Furthermore, in patients with complicated type B aortic dissection, the distance of the primary entry tear to the left subclavian artery was significantly shorter as in uncomplicated patients (8 vs. 21 mm; P = 0.002). In Cox regression analysis, a primary entry tear at the concavity of the distal aortic arch was identified as an independent predictor of the presence or the development of complicated type B aortic dissection.
  
  
  CONCLUSIONS
  A primary entry tear at the concavity of the aortic arch as well as a short distance between the primary entry tear and the left subclavian artery are frequently associated with the presence or the development of complicated acute type B aortic dissection. These findings shall help us to further differentiate acute type B aortic dissections in addition to the common categorization in complicated and uncomplicated. These findings may therefore also have an impact on primary treatment.
authors.affiliation: Department of Cardiovascular Surgery,  Hospital Hietzing, Vienna,  Austria.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Weiss
authors.forename: Ilse
authors.initials: I
authors.lastname: Wolner
authors.forename: Sandra
authors.initials: S
authors.lastname: Folkmann
authors.forename: Gottfried
authors.initials: G
authors.lastname: Sodeck
authors.forename: Jürg
authors.initials: J
authors.lastname: Schmidli
authors.forename: Martin
authors.initials: M
authors.lastname: Grabenwöger
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
mesh_terms: D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods / Q000401:mortality