Update on outcomes of acute type B aortic dissection.
BACKGROUND
The optimal treatment of acute type B aortic dissection remains controversial. This study reports early clinical outcomes of medical management for acute type B aortic dissection.


METHODS
Between January 2001 and April 2006, data on 159 consecutive patients (55 women [35%]) with the confirmed diagnosis of acute type B aortic dissection were prospectively collected and analyzed. Mean age was 62 years (range, 29 to 94). On admission, all patients were initiated on an acute type B aortic dissection protocol with the intent to manage all patients medically. Indications for surgical intervention included rupture, aortic expansion, retrograde dissection, malperfusion (visceral, peripheral), and intractable pain. All patients were followed up after discharge with serial clinical and radiographic examinations.


RESULTS
Overall hospital mortality was 8.8% (14/159): 17% (4/23) with procedural intervention, and 7.4% (10/136) when medical management was maintained. Early intervention was required in 23 patients (14.5%), of which 21 (13.2%) were open vascular/aortic procedures, and two (1.3%) were percutaneous aortic interventions. Morbidity included rupture (5.0%), stroke (5.0%), paraplegia (8.2%), bowel ischemia (5.7%), acute renal failure (20.1%), dialysis requirement (13.8%), and peripheral ischemia (3.8%). Mortality associated with complicated dissection (74/159) was 17%, and mortality associated with uncomplicated dissection (85/159) was 1.2% (p < 0.0003). Late vascular related procedures were performed in 11 (7.6%) of 144 cases (9 aortic, 2 peripheral vascular). The only independent risk factors for hospital mortality by multiple logistic regression analysis was rupture (p < 0.0009). Independent risk factors for mid-term death were history of chronic obstructive pulmonary disease (p < 0.002) and glomerular filtration rate at admission (p < 0.0001).


CONCLUSIONS
Medical management, especially for uncomplicated acute type B aortic dissection, is associated acceptable outcomes. This study provides current data for initial medical management of acute type B aortic dissection. Alternative strategies for the treatment of acute Type B aortic dissection should be compared with these results.
Estrera
Anthony L
AL
Department of Cardiothoracic and Vascular Surgery, The University of Texas-Houston Medical School, Houston, Texas 77030, USA. anthony.l.estrera@uth.tmc.edu
Miller
Charles C
CC
Goodrick
Jennifer
J
Porat
Eyal E
EE
Achouh
Paul E
PE
Dhareshwar
Jayesh
J
Meada
Riad
R
Azizzadeh
Ali
A
Safi
Hazim J
HJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001014:Aortic Aneurysm / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001019:Aortic Rupture / Q000209:etiology / Q000401:mortality; D001794:Blood Pressure / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D010166:Palliative Care; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D000959:Antihypertensive Agents