title: Optimal clinical pathway for the patient with type B acute aortic dissection.
abstract: The traditional medical treatment for type B acute aortic dissection (AAD) is widely accepted, but the optimal clinical pathway has not been confirmed. Methods and Results From admissions over the past 12 years, 210 patients with uncomplicated type B AAD were divided into 2 groups: Conventional therapy group (CG) of 90 who were treated by 7 days of bed rest and intravenous antihypertensive agents and the Clinical pathway group (CPG) of 120 who were treated by early rehabilitation. In the CPG, patients were administered oral medication from the first day after onset and took a short walk from the third day after onset. The incidence of respiratory complications, and of delirium, was significantly decreased in the CPG. Early mortality was similar: 3.3% and 2.5%, respectively. The diameter of the aorta had not enlarged in either group 1 month later. Conclusions The clinical pathway of treatment for uncomplicated type B AAD was safer and better for preventing early complications and cost benefit.
authors.affiliation: Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. tenino@med.nihon-u.ac.jp
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Niino
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Hata
authors.forename: Akira
authors.initials: A
authors.lastname: Sezai
authors.forename: Isamu
authors.initials: I
authors.lastname: Yoshitake
authors.forename: Satoshi
authors.initials: S
authors.lastname: Unosawa
authors.forename: Kazuma
authors.initials: K
authors.lastname: Shimura
authors.forename: Shunji
authors.initials: S
authors.lastname: Osaka
authors.forename: Kazutomo
authors.initials: K
authors.lastname: Minami
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000191:economics / Q000534:rehabilitation* / Q000628:therapy*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001014:Aortic Aneurysm / Q000191:economics / Q000534:rehabilitation* / Q000628:therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D016138:Walking
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers