Make Classify Criteria Of Aortic Dissection Based On 3D-CT And Study The Risk Factors For Rupture

ObjectiveFactors influencing the rupture of aortic dissection ( AD ) have not been confirmed , and the original classify criteria have not considered the factors. This study delineated the risk factors for rupture of AD as evaluated by means of a combination of three - dimensional (3D) reconstruction and clinical data analysis. Then,make a new criteria for classify.Methods1. Classify the patients by original classify criteria and calculate the percent.2. Calculate the rupture percent of each type for original classify criteria.3. Make the new classify criteria.4. Calculate the rupture percent of each type for new classify criteria.5. Image data and clinical data were assessed by means of multivariate analysis for their predictive value for rupture of AD.We obtained 3D - based data by means of computer - aided 3D reconstruction from CT studies of AD. The image data included the maximum transverse diameter of the dissection, length of the dissection, largest cross - sectional area, ratio of transverse diameter to the length of the dissection (T/L) ,the tortuosity of the intimal flap,entry site,and the mural thrombus.Clinical data were collected from patient files. The data included age of the patient, sex, tobacco use, blood pressure ( systolic pressure > 140mmHg or dias-tolic pressure >90mmHg or controlled with a durg) , diabetes mellitus( controlledby means of diet, oral durg,or insulin) ,coronay artery diseases (history of angina, myocardial infarction,or coronary artery bypass graft) ,urea nitrogen level, creatinine level,platelet count,prothrombin time,and familial AD.All data were assessed by means of multivariate analysis for their predictive value for rupture of AD.6. Calculate the rupture percent of each type which classified by the risk factors.Results1. In all patients , DeBakey type I is 15 (26. 8% ) ; type II is 3 (5. 4% ) ; type III is 38(67.8% ) . Stanford A is 18(32.1% ) ,Stanford B is38(68.9% ) .2. Rupture percent of type I is 36.4% ;type II is 100% ;type III is 24% ; rupture percent of Stanford A is 46.2% , Stanford B is 24% .3. The new criteria included the false aneurysm, the mural thrombus, and the tortuosity of the intimal flap.4. AD with false aneurysm' s rupture percent is 37. 5% ; AD without false aneurysm' s rupture percent is 27. 3% ; AD with thrombus' s rupture percent is 23% ; AD without thrombus' s rupture percent is 36% ; AD with flap tortuositys rupture percent is 4. 5% ; AD without flap tortuosity' s rupture percent is 68. 8%.5. The most efficient predictors of AD rupture was T/L,tobacco use,and the tortuosity of the intimal flap.6. AD with higher T/L's rupture percent is 81. 8% , AD with lower T/L's rupture percent is 7.7% ; patients with tobacco use's rupture percent is 55.6% , patients without tobacco use's rupture percent is 10%.ConclusionThree - dimensional - based data on AD morphology, including T/L and tortuosity of the intimal flap had strong predictive value for rupture of AD.