title: Acute type B aortic dissection: does aortic arch involvement affect management and outcomes? Insights from the International Registry of Acute Aortic Dissection (IRAD).
abstract: BACKGROUND
  Stanford Type B acute aortic dissection (TB-AAD) spares the ascending aorta and is optimally managed with medical therapy in the absence of complications. However, the treatment of TB-AAD with aortic arch involvement (AAI) remains an unresolved issue.
  
  
  RESULTS
  We examined 498 patients with TB-AAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. Kaplan-Meier mortality curves were constructed and multivariate regression models were performed to identify independent predictors of AAI and to evaluate whether AAI was an independent predictor of follow-up mortality. We found that 371 (74.5%) patients with TB-AAD did not have AAI versus 127 (25.5%) with AAI. Independent predictors of AAI were a history of previous aortic surgery (OR 3.4; 95% CI, 1.6 to 7.6; P=0.002), absence of back pain (OR 1.6; 95% CI, 1.1 to 2.5; P=0.05), and any pulse deficit (1.9; 95% CI, 1.1 to 3.3, P=0.03). Mortality for patients without AAI was 9.4%+/-4.3% and 21.0%+/-6.9% at 1 and 3 years versus 9.2%+/-7.7% and 19.9%+/-11.1% with AAI, respectively (mean follow-up overall, 2.3 years, log rank P=0.82). AAI was not an independent predictor of long-term mortality.
  
  
  CONCLUSIONS
  Patients with TB-AAD and aortic arch involvement do not differ with regards to mortality at 3 years. Whether or not AAI involvement impacts other measures of morbidity such as freedom from operation or endovascular intervention deserves further study.
authors.affiliation: University of Michigan Cardiovascular Center, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-5853, USA. hsianshi@umich.edu
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Linda
authors.initials: L
authors.lastname: Pape
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Alfredo
authors.initials: A
authors.lastname: Llovet
authors.forename: Joshua
authors.initials: J
authors.lastname: Beckman
authors.forename: Jeanna V
authors.initials: JV
authors.lastname: Cooper
authors.forename: Dean E
authors.initials: DE
authors.lastname: Smith
authors.forename: James B
authors.initials: JB
authors.lastname: Froehlich
authors.forename: Rossella
authors.initials: R
authors.lastname: Fattori
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000453:epidemiology* / Q000628:therapy*; D001013:Aorta, Thoracic / Q000473:pathology*; D001014:Aortic Aneurysm / Q000453:epidemiology* / Q000628:therapy*; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D012042:Registries; D016896:Treatment Outcome