title: Acute type B aortic dissection complicated by visceral ischemia.
abstract: OBJECTIVE
  Acute type B aortic dissection (ABAD) can lead to visceral malperfusion, a potentially life-threatening complication. The purpose of this study was to investigate the presentation, management, and outcomes of ABAD patients with visceral ischemia who are enrolled in the International Registry of Acute Aortic Dissection.
  
  
  METHODS
  Patients with ABAD enrolled in the registry between 1996 and 2013 were identified and stratified based on presence of visceral ischemia at admission. Demographics, medical history, imaging results, management, and outcomes were compared for patients with versus without visceral ischemia.
  
  
  RESULTS
  A total of 1456 ABAD patients were identified, of which 104 (7.1%) presented with visceral ischemia. Preoperative limb ischemia (28% vs 7%, P < .001) and acute renal failure (41% vs 14%, P < .001) were more common among patients with visceral ischemia. Endovascular treatment and surgery were offered to 49% and 30% of the visceral ischemia cohort, respectively; remaining patients were managed conservatively. The in-hospital mortality was 30.8% for patients with visceral ischemia and 9.1% for those without visceral ischemia (odds ratio [OR] 4.44; 95% confidence interval [CI], 2.8-7.0, P < .0001). Mortality rates were similar after surgical and endovascular management of visceral ischemia (25.8% and 25.5%, respectively, P = not significant). Among the visceral ischemia group, medical management was a predictor of mortality in multivariate analysis (OR, 5.91; 95% CI, 1.2-31.0; P = .036).
  
  
  CONCLUSIONS
  Patients with ABAD complicated by visceral ischemia have a high risk of mortality. We observed similar outcomes for patients treated by endovascular management versus surgery, whereas medical management was an independent predictor of mortality. Early diagnosis and intervention for visceral ischemia seems to be crucial.
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato, Italy; Department of Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. Electronic address: jonkerfrederik@hotmail.com.
authors.forename: Frederik H W
authors.initials: FH
authors.lastname: Jonker
authors.affiliation: Cardiac Surgery Department, University of Michigan, Ann Arbor, Mich.
authors.forename: Himanshu J
authors.initials: HJ
authors.lastname: Patel
authors.affiliation: Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville, Va.
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
authors.affiliation: Radiology Department, University of Michigan, Ann Arbor, Mich.
authors.forename: David M
authors.initials: DM
authors.lastname: Williams
authors.affiliation: Cardiovascular Center, University of Michigan, Ann Arbor, Mich.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Montgomery
authors.affiliation: Division of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Gleason
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St. Louis, Mo.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Braverman
authors.affiliation: Division of Cardiology, Robert-Bosch Krankenhaus, Stuttgart, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.affiliation: Division of Interventional Cardiology, San Salvatore Hospital, Pesaro, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Fattori
authors.affiliation: Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.affiliation: Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista
authors.affiliation: Department of Internal Medicine, University of Rostock, Rostock, Germany.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.affiliation: Thoracic Aortic Center, Massachusetts General Hospital, Boston, Mass.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.affiliation: Cardiovascular Center, University of Michigan, Ann Arbor, Mich.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato, Italy.
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000150:complications; D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D001014:Aortic Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016009:Chi-Square Distribution; D042241:Early Diagnosis; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005060:Europe; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014781:Viscera / Q000098:blood supply*