Outcome of medical and surgical treatment in patients with acute type B aortic dissection.
BACKGROUND
Optimal treatment of acute type B aortic dissection remain unclear. The aim of this study was to assess the clinical outcome of acute type B aortic dissection.


METHODS
In the last 8 years, 107 patients were admitted for acute type B aortic dissection. We medically treated patients at the time of onset with antihypertensives. Surgery was considered if there is intractable pain, uncontrolled hypertension, severe aortic branch malperfusion, or aneurysm expansion.


RESULTS
Twenty-nine patients had pleural effusion (27%), 9 patients had leg ischemia (8%), 5 patients had impending rupture, and 2 patients had aneurysm enlargement exceeding 60 mm on repeated imaging studies. A total of 16 patients (15%) underwent surgical intervention: 8 extra-anatomical bypass for leg ischemia, 1 in situ infrarenal aortoiliac bypass for distal aortic obstruction, and 7 thoracic aortic graft replacement. Of the 8 patients with extra-anatomic bypass, 3 patients died: 2 patients died of catastrophic aortic rupture 2 and 9 days after bypass, and 1 patient died of dissection progression to type A lesion 9 days after bypass. There was no in-hospital death in 92 medically treated patients. Follow-up was 92% complete. The mean follow-up duration was 36.1 months (range, 2 to 96 months). The 6-month, 1-year, and 5-year survival rates of all patients were 96.2 +/- 1.9%, 95.2% +/- 2.1%, and 95.2% +/- 2.1%.


CONCLUSIONS
Medical treatment of acute type B aortic dissection produced good outcomes. Central aortic procedures such as aortic fenestration and endovascular stenting should be the preferred methods to treat patients with acute type B aortic dissection and leg ischemia because there was high risk of central aortic complications after extra-anatomic bypass.
Hsu
Ron-Bin
RB
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC. ronbin@ha.mc.ntu.edu.tw
Ho
Yi-Lwun
YL
Chen
Robert J
RJ
Wang
Shoei-Shen
SS
Lin
Fang-Yue
FY
Chu
Shu-Hsun
SH
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000145:classification / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000145:classification / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome