Supplement 1 Jitter Plot of Propensity Score Matching Analysis
Jitter plot demonstrating the distribution of propensity scores for the
diabetes mellitus group and the no diabetes mellitus group.
Supplement
2 Aorta-related Death Cases
Ascending aortic pseudoaneurysms
are ruptured areas of the aorta in which the majority of the aortic wall
has been breached and the luminal blood is held in place only by a thin
rim of the remaining wall or adventitia. On computed tomography
aortography, the typical finding is a contrast-filled, out-pouching of
the wall of the aorta or into the thickened aortic wall in the absence
of an intimal flap or a false lumen. Retrograde type A aortic dissection
is defined as a new tear (adjacent to the proximal stent graft) caused
by manipulation or by the stent graft itself.
In the diabetes mellitus (DM) group, during the acute phase
(<14 days), two patients (Patients 13 and 14) died of sudden
aortic rupture and one patient (Patient 15) with development of type A
aortic dissection died of heart failure after emergency open surgery. In
the no DM group, three patients (Patients 1, 2 and 3) died of sudden
aortic rupture during the subacute phase (15-90 days). Two patients
(#1, #3) had a new-onset entry tear (autopsy finding) at the ascending
aorta and developed classic type A aortic dissection. By computed
tomography angiography (CTA) examinations, the development of ascending
aortic pseudoaneurysm and retrograde type A aortic dissection were
identified in Patients 2, 13 and 14.
During the follow-up period, only one patient (#16) with aorta-related
death was noted in the DM group, and in this patient, the new-onset
entry tear adjacent to the inflow anastomosis of the bypass graft used
for the arch debranching operation (presumed to be related to the injury
of the aortic wall after partial occlusion clamping) was confirmed by
autopsy findings.
The majority of aortic sudden death cases occurred during the 3 to 6
months after the onset of an intramural hematoma, and six patients
(Patients 4 to 9) in the no DM group received thoracic endovascular
aortic repair (TEVAR) treatment during the subacute phase. Five of these
six patients (Patients 5, 6, 8, 9 and 10, in the no DM group
suffered from chest/back pain after TEVAR during the subacute phase
(14-90 days) and died of retrograde type A aortic dissection or
ascending aortic pseudoaneurysm rupture. During follow-up, eight in ten
death cases involved patients who died of a ruptured retrograde type A
aortic dissection (n=5) and ascending aortic pseudoaneurysm (n=3) after
receiving TEVAR.