Early Aortic Growth in Acute Type B Aortic Dissection

Objective: Acute aortic dissection leads to destabilization of aortic wall followed by immediate aortic diameter increase. It remains unclear how the aortic diameter changes in the acute and sub-acute phase of the dissection process. The aim of this study was to evaluate the change of the aortic geometry within 30 days after the type B dissection.

Methods: Patients admitted between 2003 and 2017 due to the acute type B dissection who had at least two computed tomography angiography (CTA) scans obtained within 30 days after the onset of dissection were evaluated. The exclusion criteria were: the thrombosed false lumen, connective tissue disorders and the endovascular or open aortic repair performed prior to the second CTA.

Results: Among 190 patients with acute type B dissection [median age: 66 (first quartile: 57; third quartile: 74) years; 64% men] 43 patients met the inclusion criteria. The geometry of the aorta was analyzed according to the CTA scans obtained between 0–3 (N = 35), 4–7 (N = 9) and 8–30 (N = 12) days after the dissection. The highest aortic growth rate was observed at the level of the mid-descending aorta and was 0.5 (0.19; 0.87), 0.22 (0.06; 0.45) and 0.05 (−0.10; 0.20) mm/day at 0–3, 4–7 and 8–30 days after the dissection, respectively. There was one aortic rupture in a patient with initial mid-descending diameter of 30.8 mm and the highest aortic growth rate of 3 mm/day within the first three days after the onset of dissection.

Conclusion: An early rapid growth occurs within the first week after the type B aortic dissection with the highest intensity in the first 3 days. An additional radiographic monitoring in the acute phase of type B dissection is essential to measure aortic diameter change and to identify patients at high risk of aortic rupture.