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.