Outcomes of medical management of acute type B aortic dissection.
BACKGROUND
Currently, the optimal treatment of acute type B aortic dissection remains controversial. The purpose of this study was to report early clinical outcomes of medical management for acute type B aortic dissection.


RESULTS
Between January 2001 and March 2005, 129 consecutive patients with the confirmed diagnosis of acute type B aortic dissection were studied. Mean age was 61 years (range, 29 to 94), with 33.3% (43/129) female. Acute type B aortic dissection protocol was instituted with the intent to manage all patients medically. Indications for surgical intervention included rupture, aortic expansion, malperfusion, and intractable pain. All patients were followed-up after discharge. Hospital mortality was 10.1% (13/129), 19% (4/21) when vascular intervention was required, and 8.3% (9/108) when medical management was maintained. Early intervention was required in 21 cases (16.2%), 19 (14.7%) open vascular/aortic cases and 2 cases (1.6%) of percutaneous aortic interventions. Morbidity included rupture (4.7%), stroke (4.7%), paraplegia (8.5%), bowel ischemia (7%), acute renal failure (21%), dialysis requirement (13%), and peripheral ischemia (4.7%). Late vascular-related procedures were performed in 5.2% (6/116) of cases. Univariate risk factors for early mortality were rupture (P<0.0001), need for laparotomy (P<0.008), acute renal failure (P<0.0001), need for dialysis (P<0.0001), and lower extremity ischemia (P<0.0004). The only independent risk factors for hospital mortality by multiple logistic regression was rupture (P<0.0009), and independent risk factors for midterm death were history of chronic obstructive pulmonary disease (P<0.002) and low glomerular filtration rate (<57 mL/min; P<0.0001).


CONCLUSIONS
Medical management for acute type B aortic dissection is associated acceptable outcomes. Outcomes of other management strategies, eg, endovascular stenting, for acute type B aortic dissection need to be compared with these results.
Estrera
Anthony L
AL
Department of Cardiothoracic and Vascular Surgery, The University of Texas-Houston Medical School, Memorial Hermann Heart and Vascular Institute, 6410 Fannin St, Suite 450, Houston, Texas 77030, USA. Anthony.l.estrera@uth.tmc.edu
Miller
Charles C
CC
Safi
Hazim J
HJ
Goodrick
Jennifer S
JS
Keyhani
Arash
A
Porat
Eyal E
EE
Achouh
Paul E
PE
Meada
Riad
R
Azizzadeh
Ali
A
Dhareshwar
Jayesh
J
Allaham
Adnan
A
D000208:Acute Disease; D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D001019:Aortic Rupture / Q000209:etiology / Q000401:mortality / Q000601:surgery; D019090:Case Management; D003422:Critical Care; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D007422:Intestines / Q000098:blood supply; D007511:Ischemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010264:Paraplegia / Q000209:etiology; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D006435:Renal Dialysis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control
D000925:Anticoagulants; D000959:Antihypertensive Agents