Aortic Arch Morphology as a Predictor of Dissection Type: Unveiling the Hidden Link

Abstract

Objectives: This study aims to assess whether aortic arch anatomy, classified as Arch Type I, II, and III configuration, was associated with the Stanford aortic syndrome type at presentation.

Methods: This is a retrospective, single-centre study including patients admitted between 2006 and 2023. Stanford type A/B acute and chronic aortic syndromes, including intramural haematoma and penetrating aortic ulcer, were evaluated. Aortic anatomy and aortic syndrome patterns were assessed via contrast-enhanced CT angiography performed at disease onset. Patients underwent follow-up through outpatient visits.

Results: Throughout the study period, 846 patients presented with acute or chronic Type A or B aortic syndrome. Of these, 605 patients with baseline contrast-enhanced CT angiography were analysed. Patients were grouped by arch configuration: Arch Type I (n = 199, 32.9%), Arch Type II (n = 190, 31.4%), and Arch Type III (n = 216, 35.7%). Mean ascending aorta length and maximum diameter were significantly greater in Arch Type I, compared to Arch Type II and III (10.2 cm vs 10 cm vs 9.7 cm, MD Arch Type I vs Arch Type III 0.68, 95% CI 0.31-1.06, P < .001; 46 mm vs 43 mm vs 40.5 mm, MD Arch Type I vs Arch Type III 4.21, 95% CI 1.81-6.61, P < .001). Arch Type I was significantly associated with Type A aortic syndrome (OR 2.14, 95% CI 1.51-3.03, P < .001) and Arch Type III with Type B aortic syndrome (OR 2.28, 95% CI 1.62-3.20, P < .001). During hospital stay, 344 (56.8%) patients underwent open surgery, 147 (24.3%) endovascular treatment, 110 (18.2%) medical treatment, and 4 (0.7%) died before treatment. Thirty-day mortality in Arch Type I, Type II and Type III was 12.1%, 9.5% and 6.9% (P = .2). Kaplan-Meier analysis, restricted to treated patients with available follow-up (n = 432), showed higher 5-year survival rate in Arch Type I compared to Arch Type II and Arch Type III (HR 1.83, 95% CI 1.12-2.97, 90.1% vs 88.2% vs 87.8%, P = .05).

Conclusions: Aortic arch morphology may be associated with aortic syndrome type. Arch Type I was associated with larger and longer ascending aorta and Type A aortic disease, whereas Arch Type III emerged as a potential indicator for Type B disease.

Keywords: aortic anatomy; aortic arch; aortic syndrome.