Fate of Residual Aorta After Surgery for Type A Aortic Dissection

TL;DR

This study examines how the remaining aorta changes after surgery for type A aortic dissection and finds that partially thrombosed false lumens are linked to faster aortic growth.

Contribution

The study identifies patency and partial thrombosis of the false lumen as key factors in post-surgical aortic dilatation.

Findings

Persistent dissection flaps were found in 68% of patients after surgery.

The abdominal aorta showed the highest growth rate at 3.1 mm/year.

Partially thrombosed false lumens were associated with the most aortic dilatation.

Abstract

Surgical treatment of type A aortic dissection is essentially palliative.
Many patients who undergo the procedure still have a dissection flap in the
residual aorta, with a persistent patent or partially thrombosed false lumen
leaving them susceptible to the dilatation of distal aorta and aneurysm
formation.

Patients who had undergone surgery for type A aortic dissection from January
2015 till December 2022 were recruited into the study. Two follow-up
computed tomography scans were performed at least six months apart, the
first one at least one month after the surgery.

A persistent dissection flap was found in 34 (68%) patients. All segments of
residual distal aorta showed dilatation with time. Growth rate was maximum
for abdominal aorta - 3.1 (1.6 - 5.4) mm/year. Patency of false lumen was
the only significant factor associated with growth of lower descending
thoracic aorta and abdominal aorta (P<0.05). Maximum growth was seen in
the patients with partial thrombosis of the false lumen, followed by those
with patent false lumen. Two patients with partially thrombosed false lumens
required reintervention in the form of endovascular stenting.

Patients after surgery for type A aortic dissection with partially thrombosed
false lumens are more prone to aortic dilatation. Regular follow-up of these
patients with computed tomography aortogram can lead to timely detection of
these sequalae and intervention as needed.

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