Morphological Features of Aortic Arch Predicting the Risk for Acute Type B Aortic Dissection

The purpose of the study is to elucidate the changes in aortic morphological parameters and identify the specific geometric risk factors associated with aTBAD. A total of 167 patients in aTBAD group and 196 subjects in control group were enrolled in the study. The aortic morphological data were retrospectively analyzed by 3mensio Vascular software. The aortic morphological parameters include diameter, length, angulation, tortuosity and the type of aortic arch. Multivariable logistic regression models were developed to identify the significant predictors associated with the angulation, tortuosity and aortic arch type. The predictive capacity of the models was evaluated through the receiver operating characteristic (ROC) curve analysis. The diameters in the ascending aorta and aortic arch and the lengths in the ascending aorta and total aorta were significantly greater in aTBAD group. Besides, the angulation of the ascending aorta and aortic arch in aTBAD group increased significantly. The tortuosity of aortic arch and total aorta was significantly higher in aTBAD group. The prevalence of type III arch in aTBAD group was significantly higher than that in the controls. Multivariable models demonstrated that aortic arch angulation, tortuosity and type III arch were independent geometric predictors of aTBAD occurrence. Based on the ROC analysis, AUC of the risk prediction models was 0.977, 0.958 and 0.945, respectively. Besides the enlargement of the ascending aorta and aortic arch, incremental aortic arch angulation, tortuosity and type III arch configuration are valuable geometric risk factors that could enhance aTBAD incidence.