Is conservative therapy acceptable for thrombosed type A acute aortic dissection?
OBJECTIVE
The surgical treatment for thrombosed type A dissection is controversial because it has a better prognosis than with conservative therapy. We discuss the validity of conservative therapy for thrombosed type A dissection and examine the relationship between the morphology of the dissecting aorta and its operative indications.


METHODS
Subjects were 28 patients with acute type A aortic dissection in which the false lumen was totally thrombosed who were transferred to our hospital in the acute phase between 1990 and 2002. We performed medical therapy on all of them at first. We calculated the ratio of the false lumen and the true lumen (F/T) by enhanced computed tomography scan at the onset. The maximum aneurysmal size was measured approximately every week.


RESULTS
Fifteen of them needed surgical repair; six in the acute phase and nine in chronic. One-year and 5-year survival rate for the operative and the non-operative group are 93.3, 80.0 and 92.3, 92.3% respectively. The mean F/T was 30% in the operative group and 50% in the non-operative group (p = 0.04). There was almost no reduction in size in the operative group during the follow up (-0.5 +/- 1.2 mm).


CONCLUSIONS
Conservative therapy with frequent imaging follow-up can be a rational option for thrombosed type A acute aortic dissection. A low ratio of the false lumen and the true lumen at the onset and no reduction in the aneurysmal size are the predictive factors by which we should consider surgical repair.
Shingu
Yasushige
Y
Division of Cardiovascular Surgery, National Sapporo Hospital, 4-2, Kikusui, Shiroishiku, Sapporo 003-0804, Japan.
Myojin
Kazuhiro
K
Ishibashi
Yoshimitsu
Y
Ishii
Koji
K
Kawasaki
Masakazu
M
Ijima
Keitaro
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020519:Pericardiocentesis; D012008:Recurrence; D019233:Retreatment