ARTICLE IN PRESS
Interactive CardioVascular and Thoracic Surgery 7 (2008) 244–248
? 2008 Published by European Association for Cardio-Thoracic Surgery
Institutional report - Vascular thoracic
A study of aortic dimension in type B aortic dissection
Shang Dong Xu *, Fang Jiong Huang , Jia Hui Du , Yu Li , Zhan Ming Fan , Jin Fei Yang , Xiao Ying Yu ,
Zhao Guang Zhanga
Cardiac Surgery Division, Beijing Institute of Heart, Lung and Vascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Radiology Division, Beijing Institute of Heart, Lung and Vascular Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
Received 13 July 2007; received in revised form 8 November 2007; accepted 9 November 2007
Difference between arch diameter and true lumen diameter in the descending aorta was studied in patients with type B aortic dissection.
The diameters of the aortic arch (Proximal f) and mid-descending aorta (Distal f) were measured on computer tomography angiography
(CTA) in 20 healthy adults. Forty-two patients with type B aortic dissection who underwent endovascular repair were divided into two
groups: an acute group (23 patients) and a chronic group (19 patients). The diameters of the arch (Proximal f) and the true lumen of the
mid-descending aorta (Distal f) were measured on digital subtraction angiography (DSA) and CTA. The taper ratio was defined as (Proximal
f–Distal f)y(Proximal f)=100%. In the control group, the taper ratio was 13.0"4.7% on CTA. In the acute patients group, the taper ratio
was 23.6"11.3% on DSA and 21.9"12.1% on CTA. In the chronic patients group, the taper ratio was 31.5"13.6% on DSA and 30.1"11.4%
on CTA. In both acute and chronic type B aortic dissection, the aorta tapers significantly from arch to true lumen in the descending aorta.
Stent-graft with tapered design may be a viable treatment option for endovascular repair of type B aortic dissection.
? 2008 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
Keywords: Aortic dissection; Stent-graft; Endovascular repair
During endovascular repair of type B aortic dissection,
the proximal end of the stent-graft is positioned in the
aortic arch and the distal end in the middle portion of the
descending aorta. As the aorta tapers from the proximal to
the distal end, the diameter of the descending aorta is
smaller than that of the arch. But nowadays, during clinical
practice of endovascular repair of type B dissection, only
the proximal landing zone (the aortic arch) is used for
sizing. Most of the commercial stent-grafts used do not
have a tapered design. In this paper, tapering feature of
the aorta was studied both in healthy adults and patients
with type B aortic dissection. We want to know through
this study if there is a significant difference between arch
diameter and true lumen diameter in the descending aorta.
2. Materials and methods
2.1. Control group
Twenty healthy adults underwent computer tomography
angiography (CTA) of the thoracic aorta. There were 12
males and 8 females with a mean age of 52.7 years (S.D.
13.8, range 32–72 years). The diameters of the aortic arch
*Corresponding author. Tel.: q86-10-64456776; fax: q86-10-64443324.
E-mail address: email@example.com (S.D. Xu).
(Proximal f) and the mid-descending aorta (Distal f) were
From January 2003 to June 2005, forty-two patients with
type B aortic dissection underwent endovascular repair.
They were divided into two groups: an acute group (23
patients) and a chronic group (19 patients). In the acute
group, the time from onset of dissection to stent-graft
implantation was less than one month. In the chronic group,
the time from onset of dissection to stent-graft implanta-
tion was more than two years (range 2–10 years). Indica-
tions for endovascular repair of acute aortic dissection
were: 1) confirmation of type B aortic dissection on CTA or
magnetic resonance angiography (MRA); 2) adequate access
route for stent-graft placement; 3) landing zone diameter
-38 mm; 4) no aberrant right subclavian artery. In patients
in any of the following situations, stent-graft implantation
was performed emergently: contained rupture, organ or
extremity ischemia, signs of impending rupture (pleural
fluid), and persistent pain or refractory blood pressure. In
the chronic group, descending aorta was significantly
enlarged in each patient (total diameter of true lumen and
false lumen )40 mm). Five patients had contained rup-
ture. The study was approved by the Institutional Review
Board. Clinical characteristics of the two groups are listed
in Table 1. The primary tear was just distal to the opening