title: Morphologic predictors of aortic expansion in chronic type B aortic dissection.
abstract: OBJECTIVE
  To identify morphologic factors affecting aortic expansion in patients with uncomplicated type B aortic dissections.
  
  
  METHODS
  Computed tomography data of 24 patients (18 male; median age: 61 years), diagnosed with acute uncomplicated type B aortic dissections between 2002 and 2013, were retrospectively reviewed. All patients had at least two computed tomography angiography scans and six months of uneventful follow-up. Computed tomography scans were assessed by two independent readers with regard to presence and number of entry tears. Thoracic and abdominal aortic diameters were derived using image processing software.
  
  
  RESULTS
  Twenty-two of 24 patients showed aortic expansion over a median computed tomography angiographic follow-up of 33.2 months. Annual rates showed an increase of 1.7 mm for total aortic diameter, 2.1 mm for the false and a decrease of -0.4 mm for the true lumen. In three patients (12.5%), aortic diameter exceeded 60 mm during follow-up, and all three patients underwent thoracic endovascular aortic repair. Patients with a maximum aortic diameter <4 cm at baseline showed a significantly higher expansion rate compared to cases with an initial maximum aortic diameter of ≥4 cm (p=0.0471). A median of two entries (range: 1-5) was recognized per patient. Presence of more than two entry tears (n = 13) was associated with faster overall diameter expansion (mean annual rates: 2.18 mm vs. 1.16 mm; p = 0.4556), and decrease of the cross-sectional surface of the true lumen over time (annual rate for > 2 entries vs. ≤2 entries: -7.8 mm2 vs. +37.5 mm2; p = 0.0369). Median size of entry tears was 12 mm (range: 2-53 mm).
  
  
  CONCLUSIONS
  The results presented herein suggest that uncomplicated type B aortic dissection patients with more than two entry tears and/or an initial maximum aortic diameter of<4 cm are at risk for aortic dilatation and, therefore, may require stricter follow-up including the possible need for early intervention.
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany Drosos.Kotelis@med.uni-heidelberg.de.
authors.forename: D
authors.initials: D
authors.lastname: Kotelis
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Grebe
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Kraus
authors.affiliation: Department of Radiodiagnostics and Interventional Radiology, University Hospital Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Müller-Eschner
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Bischoff
authors.affiliation: Department of Radiodiagnostics and Interventional Radiology, University Hospital Heidelberg, Germany Institute for Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital Bern, Switzerland.
authors.forename: H
authors.initials: H
authors.lastname: von Tengg-Kobligk
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Böckler
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000628:therapy; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy; D001027:Aortography / Q000379:methods*; D002908:Chronic Disease; D000072226:Computed Tomography Angiography; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
keywords: Morphologic predictors; aortic expansion; chronic type B aortic dissection