title: Risk factors for mortality and failure of conservative treatment after aortic type B dissection.
abstract: BACKGROUND
  Despite medical treatment, one third of patients with uncomplicated type B aortic dissections experience severe late complications. The aim of this study was to identify patients at high risk of mortality during follow-up.
  
  
  METHODS
  A total of 183 patients with acute Stanford type B dissection were treated in one of the university hospitals (Aachen [Germany], Maastricht [The Netherlands], and Innsbruck [Austria]) between 1997 and 2010. Records indicated that 120 patients were treated conservatively. Of these patients, 16 were lost to follow-up. The maximum diameter, extent of the dissection, and patency of the side branches were determined from computed tomography angiography data. Survival and treatment failure were analyzed by univariate and multivariate Cox regression analysis. The univariate analysis investigated the influence of aortic diameter (≥41 vs <41 mm) on survival, and the multivariate analysis investigated the influence of aortic diameter, age, sex, and surgery on survival.
  
  
  RESULTS
  During the follow-up period, the initial treatment was converted to surgical treatment in 21 patients (20.2%). Sixteen of the 104 patients (15.4%) died after a mean of 845.5±805.9 days. The mean maximum aortic transversal diameter at admission was 41.2±8.7 mm. The multivariate analysis identified aortic diameter (P=.004; hazard ratio, 1.07) and age (P=.038; hazard ratio, 1.05) as risk factors that significantly reduce survival.
  
  
  CONCLUSIONS
  Our study revealed both early aortic dilatation and older age as risk factors for increased mortality after conservative treatment of type B dissection.
authors.affiliation: European Vascular Center Aachen-Maastricht, University Hospital RWTH, Aachen, Germany. Electronic address: jgrommes@ukaachen.de.
authors.forename: Jochen
authors.initials: J
authors.lastname: Grommes
authors.affiliation: European Vascular Center Aachen-Maastricht, University Hospital RWTH, Aachen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Greiner
authors.affiliation: European Vascular Center Aachen-Maastricht, Medical University, Maastricht, The Netherlands; Division of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Bianca
authors.initials: B
authors.lastname: Bendermacher
authors.affiliation: Department of Vascular Surgery, Medical University, Innsbruck, Austria.
authors.forename: Max
authors.initials: M
authors.lastname: Erlmeier
authors.affiliation: Department of Vascular Surgery, Medical University, Innsbruck, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Frech
authors.affiliation: European Vascular Center Aachen-Maastricht, University Hospital RWTH, Aachen, Germany.
authors.forename: Perrine
authors.initials: P
authors.lastname: Belau
authors.affiliation: Department of Medical Statistics, University Hospital RWTH, Aachen, Germany.
authors.forename: Lieven N
authors.initials: LN
authors.lastname: Kennes
authors.affiliation: Department of Vascular Surgery, Medical University, Innsbruck, Austria.
authors.forename: Gustav
authors.initials: G
authors.lastname: Fraedrich
authors.affiliation: European Vascular Center Aachen-Maastricht, Medical University, Maastricht, The Netherlands.
authors.forename: Geert Wilhelm
authors.initials: GW
authors.lastname: Schurink
authors.affiliation: European Vascular Center Aachen-Maastricht, University Hospital RWTH, Aachen, Germany; European Vascular Center Aachen-Maastricht, Medical University, Maastricht, The Netherlands.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Jacobs
authors.affiliation: Department of Vascular Surgery, Medical University, Innsbruck, Austria.
authors.forename: Josef
authors.initials: J
authors.lastname: Klocker
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D001027:Aortography / Q000379:methods; D005060:Europe; D005260:Female; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D014654:Vascular Patency