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Anatomic Sex Differences In Acute Type B Aortic Dissection
Alveena Ahmed, MD
1, Rudra Pandya, BSc
1, Oonagh Scallan, MD, FRSCS
2, John Landau, MD, MSc, FRCSC
2, Shane Smith, MD, MSc, FRCSC
2, Luc Dubois, MD, MSc, FRCSC
2, Adam Power, MD, MSc, FRCSC
2, Audra Duncan, MD, FACS, FRCSC
2.
1Schulich School of Medicine & Dentistry, Western University, London, ON, Canada,
2Division of Vascular Surgery, London Health Sciences Center - Victoria Hospital, London, ON, Canada.
OBJECTIVES: Sex differences in morbidity and mortality are well-established in Type A aortic dissections, but sex-based literature on Type-B aortic dissection (TBAD) remains scarce. Per current SVS/STS guidelines, high-risk anatomic features of TBAD inform decision-making for management. This study investigates sex-related differences in anatomic features of TBAD.
METHODS: This is a single-centre retrospective cohort study of all patients presenting with acute TBAD at our institution from 2002-2022. Data included chart review, and computed tomography angiogram (CTA) from patient’s initial presentation evaluated using TeraRecon software. Sex differences were characterized using univariate statistics to evaluate the anatomic differences. Data collection also included dissection complications including aortic rupture and malperfusion, in-hospital mortality and 5-year mortality.
RESULTS:A total of 156 patients were included. Fewer females experienced TBAD (n=57 vs. n=99), but no significant sex differences were seen in age and presenting features. Comorbidities were similar, although a higher proportion of men were smokers (female 24.6% vs. male 41%, p=0.03). Anatomically, females were more likely to have a Debakey IIIa morphology (female 45%, male 11%, p<0.001), less entry tears (female 1[1-2], male 2[1-3], p<0.001), shorter false lumen length (cm, female 25.5[15.0-33.8], male 36.75[25.6 - 43.3], p<0.001) and less branch vessel ostia originating at the false lumen (female 0[0-2], male 1[0-3], p=0.002). Men had more high-risk imaging findings per SVS/STS classification, i.e. higher likelihood of maximum tear length >1 cm (female 21%, male 37%, p=0.035), but no significant differences were found in maximal aortic diameter, radiographic malperfusion or tears on the lesser curvature of the aorta. On follow up (months, overall 20[12 - 478]), there were no significant differences in interval aortic growth, dissection propagation or false lumen thrombosis, and rates of operative (re)intervention and long-term mortality were comparable between males and females.
CONCLUSIONS: Anatomic differences in acute TBAD exist between males and females based on CTA imaging, with males presenting with more extensive dissections and with more high-risk imaging features. Based on this review, females have anatomically favourable TBAD compared to males, and any sex-based differences in TBAD outcomes should not be attributed to anatomic differences.
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