title: Impact of Retrograde Arch Extension in Acute Type B Aortic Dissection on Management and Outcomes.
abstract: BACKGROUND
  Optimal management of acute type B aortic dissection with retrograde arch extension is controversial. The effect of retrograde arch extension on operative and long-term mortality has not been studied and is not incorporated into clinical treatment pathways.
  
  
  METHODS
  The International Registry of Acute Aortic Dissection was queried for all patients presenting with acute type B dissection and an identifiable primary intimal tear. Outcomes were stratified according to management for patients with and without retrograde arch extension. Kaplan-Meier survival curves were constructed.
  
  
  RESULTS
  Between 1996 and 2014, 404 patients (mean age, 63.3 ± 13.9 years) were identified. Retrograde arch extension existed in 67 patients (16.5%). No difference in complicated presentation was noted (36.8% vs 31.7%, p = 0.46), as defined by limb or organ malperfusion, coma, rupture, and shock. Patients with or without retrograde arch extension received similar treatment, with medical management in 53.7% vs 56.5% (p = 0.68), endovascular treatment in 32.8% vs 31.1% (p = 0.78), open operation in 11.9% vs 9.5% (p = 0.54), or hybrid approach in 1.5% vs 3.0% (p = 0.70), respectively. The in-hospital mortality rate was similar for patients with (10.7%) and without (10.4%) retrograde arch extension (p = 0.96), and 5-year survival was also similar at 78.3% and 77.8%, respectively (p = 0.27).
  
  
  CONCLUSIONS
  The incidence of retrograde arch dissection involves approximately 16% of patients with acute type B dissection. In the International Registry of Acute Aortic Dissection, this entity seems not to affect management strategy or early and late death.
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato Istituto di Ricovero e Cura a Carattere Scientifico, University of Milan, Italy; Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan. Electronic address: foekenauta@gmail.com.
authors.forename: Foeke J H
authors.initials: FJ
authors.lastname: Nauta
authors.affiliation: Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Jip L
authors.initials: JL
authors.lastname: Tolenaar
authors.affiliation: Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Himanshu J
authors.initials: HJ
authors.lastname: Patel
authors.affiliation: Division of Cardiac Surgery, Libin Cardiovascular Instititue, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jehangir J
authors.initials: JJ
authors.lastname: Appoo
authors.affiliation: Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.affiliation: Cardiac Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
authors.affiliation: Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Montgomery
authors.affiliation: Vascular Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Firas F
authors.initials: FF
authors.lastname: Mussa
authors.affiliation: Heart and Vascular Center, University of Virginia, Charlottesville, Virginia.
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
authors.affiliation: Vascular Surgery, University Hospital S. Orsola, Bologna, Italy.
authors.forename: Rosella
authors.initials: R
authors.lastname: Fattori
authors.affiliation: Division of Cardiovascular Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: G Chad
authors.initials: GC
authors.lastname: Hughes
authors.affiliation: Cardiology & Aortic Centre, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.affiliation: Thoracic Aortic Center, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.affiliation: Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Thoracic Aortic Research Center, Policlinico San Donato Istituto di Ricovero e Cura a Carattere Scientifico, University of Milan, Italy.
authors.forename: Santi
authors.initials: S
authors.lastname: Trimarchi
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D057510:Endovascular Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome