CLINICAL AND INSTRUMENTAL CHARACTERISTICS OF PATIENTS WITH TYPE B DISSECTION OF THE DESCENDING THORACIC AORTA
Abstract
Introduction. Aortic dissection (AD) is a disease associated with high mortality. This condition occurs due to a disruption in the structure of the aorta inner lining; blood penetrates into the thickness of the wall and dissects its inner and outer layers, forming an additional intravascular channel (false lumen). The most common classifications of AD are: DeBakey classification – dissecting aortic aneurysm is classified into 3 types depending on the origination of dissection and its duration; and the Stanford anatomical classification dividing AD into type A and type B. Despite the fact that this disease was introduced into clinical practice by Laennec back in 1819, the accumulation of knowledge regarding optimal methods of diagnosis and treatment of type B dissection was very slow and the management of this cohort of patients still remains quite controversial.
The objective of our study was to analyze the features of clinical, laboratory and instrumental data of patients with dissection of the descending thoracic aorta (type B) under different treatment methods.
Materials and Methods. This retrospective study included adult patients (≥18 years) who were hospitalized to the State Institution "Heart Institute of the Ministry of Health of Ukraine" between 2018 and 2024 for the descending thoracic aorta dissection. The main parameters evaluated were anthropometric data, demographic characteristics, medical history, comorbidities, laboratory data, and instrumental research results.
Results. The study included 70 patients: 40 of them (group A) had underwent thoracic endovascular aneurysm repair (TEVAR) with best medical therapy (BMT) and 30 of them (group B) had been assigned best medical therapy (BMT) according to standard treatment methods. A typical profile of patients with descending thoracic aortic dissection in both groups was represented by a middle-aged or elderly man with concomitant arterial hypertension.
In patients of group A as compared to group B, we observed a significantly higher (by 16.7%) creatinine level (p=0.044); a significantly lower (by 11.7%) glomerular filtration rate (78.9±21.7 ml/min versus 88.1±22.8 ml/min, p=0.033); pleural effusion was more frequent by 18.33% (10 (25.0%) versus 2 (6.67%), p=0.044). The following parameters were also found to be higher: the frequency of dissection spreading to the abdominal aorta (by 25.0%), the frequency of intramural hematoma (by 35.0%), the maximum diameter of the false lumen (by 30.9%, p=0.001). On the contrary: the maximum diameter of the true lumen was found to be smaller by 6.22% (p=0.031) compared to group B patients.
Conclusions. Our study provides a better understanding of the clinical profile and prognosis in patients with type B aortic dissection under different treatment methods.
Downloads
References
Khaja MS, Williams DM. Aortic Dissection: Introduction. Techniques in vascular and interventional radiology. 2021;24(2):100745. https://doi.org/10.1016/j.tvir.2021.100745
Hameed I, Cifu AS, Vallabhajosyula P. Management of Thoracic Aortic Dissection. JAMA. 2023;329(9):756-757. https://doi.org/10.1001/jama.2023.0265.
Stepanova N, Driianska V, Rysyev A, Snisar L, Kolesnyk M. Low high-density lipoprotein level associated with enhanced inflammatory response and one-year persistence of long COVID in patients undergoing hemodialysis: a cross-sectional cohort study. East. Ukr. Med. J. [Internet]. 2024;12(1):128-136. https://doi.org/10.21272/eumj.2024;12(1):128-136
Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). European Heart Journal. 2014;35(41):2873-2926. https://doi.org/10.1093/eurheartj/ehu281.
Skybchyk V. Аcute aortic dissection: diagnostic, treatment and prognosis. Hypertension. 2022;3(53):48–54. https://doi.org/10.22141/2224-1485.3.53.2017.106852
Banceu CM, Banceu DM, Kauvar DS, Popentiu A, Voth V, Liebrich M, et al. Acute Aortic Syndromes from Diagnosis to Treatment—A Comprehensive Review. Journal of Clinical Medicine. 2024;13(5):1231. https://doi.org/10.3390/jcm13051231.
Shkandala AYu, Todurov BM, Furkalo SM, Khokhlov AV, Zelenchuk OV. Thoracic endovascular aneurysm repair in patients with connective tissue disorders. Cardiac Surgery and Interventional Cardiology. 2022;1-2:18-27. http://doi.org/10.31928/2305-3127-2022.1-2.1827
Huckaby LV, Gleason TG. IRAD Has a Role. Ann Thorac Surg. 2022;114(3):1085-1086. https://doi.org/10.1016/j.athoracsur.2021.09.023.
Suzuki T, Mehta RH, Ince H, Nagai R, Sakomura Y, Weber F, Sumiyoshi T, Bossone E, Trimarchi S, Cooper JV, Smith DE, Isselbacher EM, Eagle KA, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation. 2003;108 (S1):II312-7. https://doi.org/10.1161/01.cir.0000087386.07204.09.
De Bakey ME, Henly WS, Cooley DA, Morris GC, Crawford ES, Beall AC. Surgical Management of Dissecting Aneurysms of the Aorta. J Thorac Cardiovasc Surg. 1965;49:130-149.
Olsson C, Thelin S, Ståhle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation. 2006;114(24):2611-8. doi: https://doi.org/10.1161/CIRCULATIONAHA.106.630400.
Barkas F, Sener YZ, Golforoush PA, Kheirkhah A, Rodriguez-Sanchez E, Novak J, Apellaniz-Ruiz M, et al. Advancements in risk stratification and management strategies in primary cardiovascular prevention. Atherosclerosis. 2024 Aug;395:117579. https://doi.org/10.1016/j.atherosclerosis.2024.117579
Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. European Heart Journal. Published online August 30, 2024. https://doi.org/10.1093/eurheartj/ehae179
Tao Y, Li G, Yang Y, Wang Z, Wang S, Li X, et al. Epigenomics in aortic dissection: From mechanism to therapeutics. Life Sci. 2023;335:122249. https://doi.org/10.1016/j.lfs.2023.122249
Loboda A, Demikhova N, Smiianova O, Yasenok V. Improvement of the medical care quality management model based on the internal audit mechanism in the healthcare facility. Eastern Ukrainian Medical Journal. 2023;11(2):171-177. https://doi.org/10.21272/eumj.2023;11(2):171-177
Demikhov O, Dehtyarova I, Motrechko V et al. Management aspects of children’s health: dysplastic-dependent pathology of the bronchopulmonary system and ecological heterogeneity of the environment. Azerbaijan Medical Journal. 2022;1:144-150. https://doi.org/10.34921/amj.2022.1.023
Marushchak M, Krynytska I, Lepyavko A. Association of serum uric acid with albuminuria in type 2 diabetic patients with comorbid obesity and/or essential arterial hypertension. Ukrainian Journal of Nephrology and Dialysis, 2022;1(73):58-69. https://doi.org/10.31450/ukrjnd.1(73).2022.07
Chernatska O, Demikhova N, Rudenko T, Demikhov A. Assessment of the lipid profile correction in patients with arterial hypertension and type 2 diabetes mellitus. Azerbaijan Medical Journal. 2019;1:95-99.
Tanaka A, Hebert AM, Smith-Washington A, Hoffstaetter T, Goldenberg R, Vemulapalli S, et al. Knowledge gaps in surgical management for aortic dissection. Seminars in vascular surgery. 2022;35(1):35-42. https://doi.org/10.1053/j.semvascsurg.2022.02.009.
Budtz-Lilly J, D'Oria M, Gallitto E, Bertoglio L, Kölbel T, Lindström D, et al. European Multicentric Experience With Fenestrated-branched ENDOvascular Stent Grafting After Previous FAILed Infrarenal Aortic Repair: The EU-FBENDO-FAIL Registry. Ann Surg. 2023;278(2):e389-e395. https://doi.org/10.1097/SLA.0000000000005577.
Mussa FF. TEVAR in TBAD with high-risk features? Not so quickly!!! J Vasc Surg. 2022;76(2):372. https://doi.org/10.1016/j.jvs.2022.03.878.
Tadros RO, Tang GHL, Barnes HJ, Mousavi I, Kovacic JC, Faries P, et al. Optimal Treatment of Uncomplicated Type B Aortic Dissection: JACC Review Topic of the Week. J Am Coll Cardiol. 2019;74(11):1494-1504. https://doi.org/10.1016/j.jacc.2019.07.063.
Tracci MC, Clouse WD. Management of Acute, Uncomplicated Type B Aortic Dissection. Tech Vasc Interv Radiol. 2021;24(2):100749. https://doi.org/10.1016/j.tvir.2021.100749.
Lovato L, Cefarelli M, Gatta E, Di Eusanio M, Fattori R. Devices for thoracic endovascular aortic repair of type B aortic dissection: is there any chance for Marfan syndrome? Expert Rev Med Devices. 2020;17(7):683-696. https://doi.org/10.1080/17434440.2020.1782735.
Kaji S. Update on the Therapeutic Strategy of Type B Aortic Dissection. J Atheroscler Thromb. 2018;25(3):203-212. https://doi.org/10.5551/jat.RV17017.
Zelenchuk, O., Stetsyuk, I., Sudakevych, S., Yashchenko, N., Polishchuk, O., Rotar, M. and Todurov, B. 2024. ASSESSMENT OF PATIENTS’ QUALITY OF LIFE AFTER DAVID SURGERY. Eastern Ukrainian Medical Journal. 12, 3 (Sep. 2024), 551-558. DOI: https://doi.org/10.21272/eumj.2024;12(3):551-558
Vitovskyi, A., Loskutov, O. (2024). Changes in hemodynamic parameters with different anaesthesia induction agents in elderly patients with coronary heart disease. EMERGENCY MEDICINE, 20(7), 594–600. https://doi.org/10.22141/2224-0586.20.7.2024.1778
This work is licensed under a Creative Commons Attribution 4.0 International License.
ISSN: 
