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CTA Imaging Features Related to Preoperative Coagulopathy in Patients with Stanford Type A Acute Aortic Dissection

  • Author Footnotes
    # Three authors contributed equally to the first author in this work.
    Yu Li
    Footnotes
    # Three authors contributed equally to the first author in this work.
    Affiliations
    Department of Radiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China

    Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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  • Author Footnotes
    # Three authors contributed equally to the first author in this work.
    Mingming Zhao
    Footnotes
    # Three authors contributed equally to the first author in this work.
    Affiliations
    Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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  • Author Footnotes
    # Three authors contributed equally to the first author in this work.
    Jiaqi Tong
    Footnotes
    # Three authors contributed equally to the first author in this work.
    Affiliations
    Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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  • Liwei Liu
    Affiliations
    Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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  • WeiPing Cheng
    Affiliations
    Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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  • Nan Zhang
    Affiliations
    Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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  • Junming Zhu
    Correspondence
    Correspondence to: Dr. Mu Jin, MD, Department of Anaesthesiology, Beijing Friendship Hospital, Capital Medical University, N0.2 YongAn Road, XiCheng District, Beijing 100032, China
    Affiliations
    Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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  • Mu Jin
    Correspondence
    Dr. Junming Zhu, M.D., Department of Cardiac Surgery, Beijing Anzhen Hospital Capital Medical University, Beijing, China
    Affiliations
    Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
    Search for articles by this author
  • Author Footnotes
    # Three authors contributed equally to the first author in this work.
Published:December 18, 2021DOI:https://doi.org/10.1016/j.avsg.2021.11.017

      Background

      Stanford type A acute aortic dissection (TAAAD) is often accompanied by preoperative disorders of coagulation. The study aimed to evaluate the relationship between computed tomography angiography imaging features and preoperative coagulopathy in TAAAD patients.

      Methods

      This was a single-center retrospective review of adult patients undergoing TAAAD surgery from January 2015 to January 2019 in the Beijing Anzhen Hospital (Beijing, China). Images were obtained using preoperative enhanced computed tomography in 174 patients with TAAAD. Preoperative coagulopathy was defined as the disseminated intravascular coagulation score greater than 5. The patients were divided into coagulopathy and non-coagulopathy groups. Circumferential arc lengths of the false lumen (Fx) and true lumen (Tx) were measured at four planes (ascending aorta, thoracic-descending aorta, descending aorta and abdominal aorta). We define the value of Fx/(Tx+Fx) × 100% as tear index (TI) and take the four planes' averages to weighed the false lumen's size. By analyzing the two groups of clinical data and computed tomography angiography imaging data, potentially related factors were detected by univariate analysis and multivariate binary logistic regression analysis.

      Results

      The incidence of preoperative coagulopathy for TAAAD patients was 12.07%. In adjusted multivariate binary logistic regression analysis, white blood cell count (odds ratio [OR]: 1.204, 95% confidence interval [CI]: 1.035–1.400, P = 0.016); longitude length of aortic dissection (OR: 1.076, 95% CI: 1.016–1.139, P = 0.012); and Tear index (OR = 1.177, 95% CI: 1.075–1.289, P < 0.001) were significant factors related to the occurrence of preoperative coagulopathy for TAAAD.

      Conclusions

      The incidence of preoperative coagulopathy in TAAAD patients was 12.07%. The longitude length of AD, TI and white blood cell count were significant factors related to preoperative coagulopathy in patients with TAAAD. The significance of imaging and anatomic changes related to coagulopathy are worth further study in TAAAD patients.
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