Impact of new development of ulcer-like projection on clinical outcomes in patients with type B aortic dissection with closed and thrombosed false lumen.
BACKGROUND
The purpose of this study was to investigate the clinical importance of newly developed ulcer-like projection (ULP) in patients with type B aortic dissection with closed and thrombosed false lumen (AD with CTFL), which is better known as aortic intramural hematoma.


RESULTS
A total of 170 patients with acute type B AD with CTFL were admitted to our institution from 1986 to 2008 and treated initially with medical therapy. There were 31 late deaths, including 9 cases of aortic rupture. The actuarial survival rates of all patients were 99%, 89%, 83% at 1, 5, and 10 years, respectively. A total of 62 (36%) patients showed new ULP development within 30 days from the onset. Patients who had ULP showed significantly poorer survival rates than patients who did not have ULP (P=0.037). Development of ULP was also associated with a significant increase in adverse aorta-related events (P<0.001). In addition, patients with ULP in the proximal descending thoracic aorta (PD) showed significantly higher aorta-related event rates than patients without ULP in the PD (P<0.001). Initial aortic diameter (hazard ratio, 3.55; P<0.001) and development of ULP in PD (hazard ratio, 3.79; P=0.003) were the strongest predictors of adverse aorta-related events.


CONCLUSIONS
Initial aortic diameter and development of ULP in the PD are both strong predictors of adverse aorta-related events in patients with type B AD with CTFL. Patients with newly developed ULP should be more carefully followed up with close surveillance imaging than those without ULP.
Kitai
Takeshi
T
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan.
Kaji
Shuichiro
S
Yamamuro
Atsushi
A
Tani
Tomoko
T
Kinoshita
Makoto
M
Ehara
Natsuhiko
N
Kobori
Atsushi
A
Kita
Toru
T
Furukawa
Yutaka
Y
D000368:Aged; D001019:Aortic Rupture / Q000401:mortality / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006406:Hematoma / Q000401:mortality / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013927:Thrombosis / Q000401:mortality / Q000473:pathology; D014456:Ulcer / Q000401:mortality / Q000473:pathology