Low rates of aortic surveillance imaging and clinical follow-up in patients with acute aortic dissection

Colleen P Flanagan; Alexander S Kim; Joel L Ramirez; Sowmya A Mangipudi; Eric J T Smith; Michael S Conte; Jade S Hiramoto

doi:10.1016/j.jvs.2024.12.041

Low rates of aortic surveillance imaging and clinical follow-up in patients with acute aortic dissection

J Vasc Surg. 2024 Dec 24:S0741-5214(24)02237-7. doi: 10.1016/j.jvs.2024.12.041. Online ahead of print.

Authors

Colleen P Flanagan¹, Alexander S Kim², Joel L Ramirez², Sowmya A Mangipudi², Eric J T Smith², Michael S Conte², Jade S Hiramoto²

Affiliations

¹ Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA; Division of Clinical Informatics and Digital Transformation, Department of Medicine, University of California San Francisco, San Francisco, CA. Electronic address: [email protected].
² Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA.

PMID: 39725243
DOI: 10.1016/j.jvs.2024.12.041

Abstract

Objectives: Patients that survive acute aortic dissection (AD) remain at high risk of morbidity/mortality from structural changes of the aorta. Aortic surveillance is challenging, especially within a tertiary referral center. Our aim was to identify follow-up imaging and appointment rates, and factors associated with incomplete surveillance in patients with acute AD.

Methods: This was a single-center, retrospective study of acute AD patients at a tertiary care center from 7/2012 to 12/2022 that lived at least 1 year post-AD. We defined complete surveillance as having CT or MRI scans of chest/abdomen at 1 month (± 14 days), 6 months (± 1.5 months), 1 year (± 3 months), and yearly thereafter. Data were obtained from the electronic health record. Predictors of absent imaging at the 1 year (± 3 months) timepoint were evaluated using multivariable logistic regression.

Results: Of the 272 patients in the study, 63.2% were male and 39.3% were white. The average age was 60.7 ± 14.7 years. Acute Type A AD (TAAD) comprised 47.1% of our cohort; 91.4% underwent open repair within 1 week of presentation. Of the acute Type B AD (TBAD) patients (52.9% of cohort), 41.7% underwent thoracic endovascular aortic repair (TEVAR) on the index admission. At the 1-year follow up interval (± 3 months), 26.5% were confirmed to have undergone aortic surveillance imaging, and 27.6% had an appointment with a cardiovascular specialist. Only 9.6% of the cohort was fully concordant with the recommended surveillance imaging in the first year of follow-up. On multivariate regression, non-English speakers (OR 1.19, 95% CI 1.05-3.99, p=0.03) and residence outside of hospital region (OR 1.66, 95% CI 1.02-3.17, p=0.04) were independently-associated with lack of follow-up imaging at the 1-year timepoint, whereas longer length of stay was independently-associated with completed imaging at the 1-year timepoint (OR 0.78, 95% CI 0.41-0.89, p=0.04).

Conclusion: This study highlights a low rate of surveillance and clinical follow-up for acute AD patients and a significant disparity for non-English speaking patients and those who reside outside of the hospital region. This information should inform future quality initiatives to improve aortic surveillance following AD.

Keywords: acute aortic dissection; imaging surveillance; quality improvement.