title: A treatment strategy for early thrombosed Stanford type A acute aortic dissection.
abstract: OBJECTIVE
  Early thrombosed aortic dissection is a form of aortic dissection and includes the condition called aortic intramural hematoma. It was generally considered as surgical emergency. However, the optimal treatment strategy for acute type A intramural hematoma is becoming controversial after recent studies indicated more benign clinical course for this disease. We evaluated our strategy that integrated medical therapy, serial imaging, and timed surgery.
  
  
  METHODS
  We reviewed 34 consecutive patients who were admitted to our hospital for early thrombosed Stanford type A acute aortic dissection from 2006 to 2011. Medical therapy or timed surgery was offered on the basis of radiological findings. Emergency or urgent surgery was not considered for a hemodynamically stable patient unless the ascending aortic diameter was ≧50 mm or the thickness of the thrombosed false lumen was ≧10 mm. Follow-up computed tomography was performed to detect a potential progression to aortic dissection.
  
  
  RESULTS
  During the average follow-up period of 24.3 months, there was no aortic dissection-related mortality. And aortic dissection-related event was not recorded in patients who had surgical repair; however, in patients who did not have surgery, 3 (8.8 %) surgical conversions were recorded due to aortic dissection progression during the follow-up period. Twenty-one patients (61.8 %) ultimately had surgical repair, and 13 patients (38.2 %) had complete medical therapy. The overall survival rate at 3 years was 86.5 %.
  
  
  CONCLUSIONS
  Our strategy for the treatment of early thrombosed Stanford type A acute aortic dissection is reasonable, and the mid-term results were acceptable.
authors.affiliation: Thoracic and Cardiovascular Surgery, Sapporo Medical University, S1W16 Chuo-ku Sapporo, Hokkaido, 060-8543, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Uzuka
authors.forename: Toshiro
authors.initials: T
authors.lastname: Ito
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hagiwara
authors.forename: Yohsuke
authors.initials: Y
authors.lastname: Yanase
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Koyanagi
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kurimoto
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Kawaharada
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Higami
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D018450:Disease Progression; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D015996:Survival Rate; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D014057:Tomography, X-Ray Computed