Adherence to recommended imaging surveillance of acutely presenting Stanford type-B aortic dissections. (October 2019) - Doshi, Sachin
Objective: Acutely presenting Stanford type B aortic dissections (type-B AD) primarily receive medical or endovascular management and require lifelong imaging surveillance. CT and MR imaging are the best modalities to assess early indications of potentially fatal developments. Published guidelines recommend that imaging occur at 1, 3, 6, and 12 months following acute presentation, and annually thereafter. This study evaluates adherence to recommended imaging surveillance for newly presenting type-B AD patients at a tertiary hospital. Methods: A retrospective review of patients presenting with a new, acute type-B AD between January 2010 and March 2017 was performed. Patient demographics, type-B AD admission details, and medical histories were obtained from electronic and paper chart reviews. CT and MR images were reviewed, and aortic sizes were measured by two independent radiologists. Patients without a clinical visit or type-B AD surveillance imaging for greater than 15 months were considered lost to follow-up after their last appointment. Overall clinical follow-up and adherence to recommended were analyzed using Kaplan–Meier graphs. Log-rank analysis assessed factors increasing risk of poor clinical follow-up and adherence to surveillance guidelines. Results: Sixty-two patients (38 male, 24 female) were included. At the time of index admission, median age was 62 (SD 14), and median aortic diameter was 45 mm (SD 11.2). Median duration of overall follow-up was 24 months. Kaplan–Meier analysis of overall follow-up, censoring death, and external follow-up, indicated clinical follow-up rates of 87.1% (SE = 4.3%) at 3 months, 85.2% (SE = 4.6%) at 6 months, 77.5% (SE = 5.6%) at 12 months, and 63.8% (SE = 8.1%) at 60 months. Similar analysis of adherence to recommended imaging surveillance revealed rates of 56.5% (SE 6.3%) at 3 months, 36.9% (6.7%) at 6 months, 21.5% (6.5%) at 12 months, and 12.9% (6.1%) at 24 months. Log-rank analysis indicated that specialty arranging follow-up – medical ( n = 24) versus surgical ( n = 38) – did not impact overall follow-up or adherence to recommended guidelines. Similarly, none of patient distance to hospital, medical versus endovascular intervention, initial dissection size, smoking history, or additional medical/demographic impacted these outcomes. Conclusions: At our institution, we identified a gap between imaging surveillance following type-B AD and adherence to recommended, published guidelines. This was consistent across all type-B AD patients with no subset in isolation. Multiple opportunities for quality improvement exist to facilitate improved compliance with published guidelines.