| Objectives:To summarize the epidemiology,clinical manifestations,CT imaging features and treatment of patients with type B aortic dissection in our hospital in the past decade,and to compare the changes during the 10 years.Methods:Retrospective analysis was made of patients admitted in our hospital with TBAD diagnosed by aortic CT examination from January 1,2010 to December 31,2019.Clinical data and aortic CT images were collected.Patients with postoperative aortic dissection,congenital heart disease,missing basic clinical data,unanalyzable CT images were excluded.Continuous variables were compared by independent sample t-test or Mann-Whitney U test,categorical variables were compared by chi-square test,the trend of counting data was evaluated by analysis of variance trend test,and the trend of measurement data was evaluated by chi-square trend test.Results:A total of 929 patients with TBAD were enrolled in this study,81.7%were men,with an average age of 47.80 years,and an average BMI of 26.55 kg/m2.84.4%had a history of hypertension,and the number of hypertension showed an increasing trend in the past decade,only 6.0%with diabetes,and 72.2%were in the acute phase when they admitted.Pain was the most common symptom at admission,accounting for 94.3%,and 57.2%patients’ blood pressure within the normal range at admission.The most patients visited in winter,accounting for 29.4%,and the least in summer,accounting for 20.2%.The average maximum diameter of aortic dissection was 44.36 ± 12.20mm,and the maximum section area was 12.78±7.50cm2;Aorta of women was wider than men(diameter P=0.003,section area P=0.014).There was no difference in the length of involved aorta and the proportion of arch involvement between the genders(370.28±79.27mm vs.349.82±73.41mm,P=0.376,and 15.9%vs.14.7%,P=0.689).Less than 10%of patients with multiple false lumens had similar proportions between genders(8.4%vs.8.2%,P=0.933).More than half of the patients had thrombosis in the false lumen,and there’s no significant differences between genders(53.5%vs.58.2%,P=0.262).In terms of the CT findings of complicated dissection,there were no significant differences in renal malperfusion,hemopericardial,hemothorax,mediastinal hematoma and abdominal hematoma between genders(27.9%VS.24.1%,P=0.313,0.9%VS.1.2%,P=1.000,1.8%VS.1.8%,P=1.000,1.4%VS.0.6%,P=0.612,0.4%VS.0%,P=0.729).In terms of the involvement of abdominal branch vessels,the involvement of celiac trunk and superior mesenteric artery were more in men than in women(6.8%vs.1.8%,P=0.011,8.7%vs.3.5%,P=0.023).There was no significant difference in the propotion of involved renal artery and iliac artery between genders(7.8%vs.4.1%,P=0.094,14.5%vs.9.4%,P=0.080).Within 10 years,the proportion of patients receiving conservative medication,endovascular repair,hybrid operation and surgical operation accounted for 11.2%,66.5%,12.2%and 10.1%,respectively.During 10 years,the number of patients receiving medical treatment showed an increasing trend(P<0.001,R=0.179),while the number of patients receiving endovascular treatment and surgical treatment showed a decreasing trend(P=0.012,R=-0.083,P=0.011,R=-0.083),and hybrid surgery did not show a significant trend(P=0.472,R=0.024).Conclusion:Chinese patients with TBAD were younger than those in western countries,and the proportion of man was higher.Hypertension was the most common cause and has increased over the past decade;Winter was the peak season of the disease.The celiac trunk and superior mesenteric artery were more likely to be involved in men.Endovascular repair has remained the main treatment,and patients receiving medical treatment showed an increasing trend.Objectives:To compare the CT images of patients with acute,subacute and chronic type B aortic dissection(TBAD),and to summarize the features and differences of CT images in different phases.Methods:Patients underwent aortic CTA and diagnosed with type B aortic dissection(TBAD)in our hospital from January 1,2010 to December 31,2019 were included in our study.Patients with postoperative aortic dissection,congenital heart disease,missing basic clinical data,unanalyzable CT images,lost to follow-up,or who provided inaccurate information were excluded.According to the course of disease,patients were divided into acute,sub-acute and chronic phase,which refer to the onset of symptoms within 14 days,15-90 days,or longer than 90 days,respectively.The CT findings of different phases were compared.Analysis of variance was used for continuous variables and chi-square test was used for classification variables.Results:A total of 929 patients with TBAD were enrolled in this study,with 72.2%,15.7%,and 12.1%of patients in acute phase,sub-acute phase,and chronic phase,respectively.There was no statistical difference in the age,gender ratio and body surface area among the three phases(age:acute phase:50.36±11.34 years old,sub-acute phase:51.66±12.66 years old,chronic phase:52.29±13.41 years old,P=0.068;male ratio,acute phase:83.2%,sub-acute phase:79.5%,chronic phase:75.9%,P=0.137;body surface area:acute phase:0.84±0.17,sub-acute phase:0.81±0.17,chronic phase:0.82± 0.17,P = 0.098).In terms of CT findings,the dissection in chronic phase was wider than that in sub-acute phase and acute phase,and there was a statistical difference among the three phases and between each two groups(the maximum diameter was 52.85 ±15.17mm,48.71 ± 13.20mm,41.97± 10.41mm,respectively,P<0.001,chronic phase VS.Sub-acute phase P=0.020,sub-acute phase vs.acute phase P<0.001;The maximum cross-sectional area was 17.47 ± 9.98cm2,15.27±8.39cm2,and 11.46 ± 6.28cm2,respectively,chronic phase VS.Sub-acute phase P=0.045,sub-acute phase VS.acute phase P<0.001).In terms of false lumen thrombosis,most patients in chronic phase,and there was a statistical difference among the three phases(chronic phase:73.2%,subacute phase:68.5%,acute phase:49.6%,P<0.001),and there was a difference between acute and subacute phase(P<0.001),but no difference between chronic and subacute phase(P=0.410).The length of dissected aorta was similar(367.24±73.78mm,369.70±80.62mm,358.08±101.17mm,P=0.455),and the proportion of arch involvement was similar(15.6%,17.1%,14.3%,P=0.821).There was no significant difference in the proportion of involved vessels in each abdominal branch(celiac axis:6.6%,4.8%,4.5%,P=0.547;superior mesenteric artery:7.7%,8.2%,7.1%,P-0.950;renal artery:7.6%,6.2%,7.1%,P=0.831).There was no significant difference in patients with multiple false lumens(7.6%,11.0%,9.8%,P=0.351).About 1/3 of the patients had renal malperfusion in all the three phases,and there was no significant difference(25.63%,30.1%,33.0%,P=0.184).Pericardial hematoma,pleural hematoma,mediastinal hematoma,and abdominal hematoma accounted for less than 3%,mainly in the acute phase(pericardial hematoma:1.34%vs.0%vs.0%,P=0.286;pleural hematocele:2.1%vs.1.4%vs.0.9%,P=0.787;mediastinal hematoma:1.64%vs.0.7%vs.0%,P=0.503;abdominal hematoma:0.4%vs.0.7%vs.0%,P=0.729)Conclusion:The lumen in chronic phase of TBAD was widest,and the thrombus in false lumen was more common in the chronic and subacute phase.However,there was no difference in the range of dissection and proportion of renal perfusion defect in each phase.Objectives:According to manifestations on CT,patients with type B aortic dissection(TBAD)were divided into "CT-complicated group" and "CT-complicated group".The correlation between treatment methods and prognosis of the two groups was analyzed respectively,and the risk factors for predicting death were found.Methods:Patients underwent aortic CTA and diagnosed with type B aortic dissection(TBAD)in our hospital from January 1,2010 to December 31,2019 were included in our study.Follow-up by telephone was conducted ended in March 2021,with an endpoint of all-cause death.Patients with postoperative aortic dissection,congenital heart disease,missing basic clinical data,unanalyzable CT images,lost to follow-up,or who provided inaccurate information were excluded.According to CT images,the patients were divided into "CT-complicated group" and "CT-uncomplicated group".CT-complicated showed signs of aortic rupture,including pleural hematoma,pericardial hematoma,mediastinal hematoma,abdominal hematoma,or signs of malperfusion.Cox proportional risk regression model was used to determine the independent predictors of death in the two groups,respectively.Cut-off value of continuous variable was found by Receiver Operating Characteristic curve.Kaplan-Meier and Log-rank test estimate and compare the cumulative probability of death.The area under characteristic curve(AUC)was used to evaluate the predictive value of mortality without and without CT values and the difference between the two groups.Results:A total of 790 patients were enrolled in this study,with a mean age of 47.8±12.3 years(81.1%men)and a median follow-up time of 52 months.A total of 609 patients were included in the CT-complicated group,with a mean age of 45.6±11.8 years,and 80.6%were men.Age and maximum diameter of aortic dissection were risk factors for death(age:HR=1.069,P=0.001,maximum diameter of aortic dissection:HR=1.047,P=0.001),while BMI and intervention were protective factors for death(BMI:HR=0.732,P<0.001,intervention:HR=0.050,P=0.001);The accuracy of predicting death increased by 10.2%by adding CT index(P=0.024).A total of 181 patients in the CT-uncomplicated group,with an average age of 56.7±11.7 years,and 82.9%were men.Maximum cross-sectional area of aortic dissection was a risk factor(HR=1.048,P=0.025),while BMI and intervention were protective factors(BMI:HR=0.787,P=0.022,intervention:HR=0.050,P=0.001).The accuracy of predicting death increased by 24.3%by adding CT index(P=0.002).Conclusion:Intervention reduced risk of death for patients with TBAD regardless of whether there are complex manifestation on CT images.Old age was a risk factor and BMI was a protective factor for death.CT parameter can significantly improve the accuracy of death prediction.The maximum diameter and maximum cross-section area of aortic dissection were predictors of death for patients in CT-complicated group and CT-uncomplicated group,respectively. |
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