[Acute aortic dissection. Diagnosis and therapy of ischemic complications].
OBJECTIVE
About 30% of the patients with acute aortic dissection suffer from organ or limb ischemia. We analyzed the influence of ischemic localization and method of operative treatment (aortic fenestration or extraanatomic bypass revascularization) on morbidity and mortality.


METHODS
From 1 May 1987 to 31 December 1998 21 patients with 24 vascular complications such as renal or intestinal ischemia, lower extremity ischemia and paraplegia following acute aortic dissection were treated at our institution. Recruitment was retrospective in 16 and prospective in 5 patients. In 5 patients (24%) the complication was associated with Stanford A, in 16 (76%) with Stanford B dissection. Ten patients (48%) complained of malperfusion of only one region, whereas 11 patients (52%) suffered from ischemia of two or three different regions. Aortic fenestration and resection of the dissected membrane was performed in nine cases (37%). Fifteen patients (63%) were treated with extraanatomic bypass techniques.


RESULTS
One third of the patients died, four of them due to aortic penetration or perforation and two due to visceral ischemia. During follow-up of 32 (1-110) months two patients developed aortic complications. One died of aortic perforation, while the other developed a thoracoabdominal aneurysm and had to be treated by a tube graft replacement.


CONCLUSIONS
Outcome depended more on the spontaneous course of aortic dissection and on prompt diagnosis and therapy of the complications than on the different operative techniques.
Müller
B T
BT
Klinik für Gefässchirurgie und Nierentransplantation, Heinrich-Heine-Universität Düsseldorf.
Grabitz
K
K
Fürst
G
G
Sandmann
W
W
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D007668:Kidney / Q000098:blood supply; D007866:Leg / Q000098:blood supply; D008297:Male; D008643:Mesentery / Q000098:blood supply; D008875:Middle Aged; D010264:Paraplegia / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery; D013116:Spinal Cord / Q000098:blood supply; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014781:Viscera / Q000098:blood supply