Clotted false lumen: reappraisal of indications for medical management of acute aortic dissection.

Sanderson, Cody J.; Rich, Stuart; Beere, Polly A.; Anagnostopoulos, Constantine E.; Levett, James M.; Lawrence, J M

doi:10.1136/thx.36.3.194

Cited by 21 publications

(3 citation statements)

References 7 publications

(4 reference statements)

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“…12,13 However, it has since been reported that thrombosed false lumen (or intramural hematoma) is not necessarily a factor of good prognosis, [14][15][16][17] because there were patients with thrombosed lumen who were first treated medically and then needed surgery during follow up, especially among those with Stanford type A dissection. In the present study, the status of false lumen was not the only variable that was an independent predictor of event.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Prognosis of Acute Aortic Dissection With Medical Treatment. A Survey of 263 Unoperated Patients.

et al. 2001

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cute aortic dissection has a poor prognosis without therapy. Since 1955, DeBakey et al have reported surgical treatment for aortic dissection and classified aortic dissections as 3 types. 1,2 Thereafter, a simpler categorization, the Stanford classification, was proposed in 1970. 3 The most proximal type dissection was subjected to surgery and the peripheral type dissection without severe complications was treated medically. In addition to the site of the aortic dissection, we are also able to detect the state of the false lumen. The thrombosed false lumen was detected by angiography in 1966 4 and by computed tomography (CT) scan in 1981. 5 Several investigators have reported that aortic dissection with thrombosed false lumen has a better prognosis than with open false lumen. However, the method of treating dissecting aorta with open or thrombosed lumen has not yet been clearly determined. The purpose of the present study is to evaluate the long-term prognosis of each type of aortic dissection undergoing medical treatment and to determine the factors that would indicate the most suitable treatment.We have previously reported the results of dissecting aorta with medical treatment. 6 The present study has more patients than in our previous report, and we can determine the condition of false lumen for diagnosing aortic dissection with thrombosed false lumen. MethodsThe subjects in the present study are 263 patients with Japanese Circulation Journal Vol.65, May 2001 aortic dissection medically treated only. They were selected from 541 patients admitted to the Internal Medicine Departments of Chiba University Hospital and 14 affiliated hospitals between 1973 and 1998. Aortic dissection was diagnosed based on the detection of 2 aortic lumens with blood flow or thrombus by enhanced CT, transesophageal echocardiography or autopsy. Patients with high blood pressure were administered antihypertensive drugs, and for a shock state dopamine or dobutamine was used. Although most patients with Marfan's syndrome were operated, there were 9 patients treated only medically. Patients who were found to have an aortic dissection at the chronic phase were excluded from the study. ClassificationAortic dissections are classified according to the site of dissection and the state of false lumen. In the present study, patients were classified into 4 groups: (i) Stanford type A dissection with open false lumen (AO group); (ii) Stanford type B dissection with open false lumen (BO group); (iii) Stanford type A dissection with thrombosed false lumen (AT group); and (iv) Stanford type B dissection with thrombosed false lumen (BT group). At first, the survival rate with medical treatment only was analyzed in each group. Second, the event-free rate was analyzed. Event was defined as death-related with dissection or re-dissection. Third, gender, age, maximum diameter of dissected aorta, and the presence of shock at onset were examined as factors related to the event. StatisticsThe survival rate and event-free rate were analyzed by the Kaplan-M...

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Section: Discussionmentioning

confidence: 99%

Long-Term Prognosis of Acute Aortic Dissection With Medical Treatment. A Survey of 263 Unoperated Patients.

et al. 2001

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“…It is noteworthy that although thrombosis of the false lumen is in and of itself a good prognostic indicator, 27 it does not always prevent aneurysm formation and rupture, highlighting the need for close long-term surveillance in all cases. 28 In our institution, we treated 77 patients with type B aortic dissection during the same 7.5-year period mentioned above. Sixty-four (83%) had acute dissection (defined as treatment within 2 weeks of clinical onset).…”

Section: Chronic Aortic Dissectionmentioning

confidence: 99%

A Decade of Thoracic Endografting: Planning the Next 10 Years…

Abul-Khoudoud

Criado

2004

J Endovasc Ther

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Endovascular repair has emerged as a very important treatment modality in the management of a host of serious and relatively frequent thoracic aortic diseases. This minimally invasive approach is certain to revolutionize the entire field of thoracic aortic surgery in the near future. The technologies, however, can still be considered as a ''work in progress.'' Future refinements, which should be available within the next 1 to 2 years, will address some of the most important needs as yet unmet today: lower profile (Ͻ22 F) delivery systems, greater device flexibility, no longitudinal metal bars, and precise deliverability and deployment characteristics that will be conducive to optimal success and safety, especially in the region of the aortic arch.

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“…and Crawford [I 1].Several reports have been published on the subject of T-type dissections[12]; however, their precise clinical features -The actuarial survival curve in patients with Stanford type B dissection; a comparison of patients who had undergone surgery with those who were given no surgical intervention. The actuarial survival rates for patients with Stanford type B dissection were not significantly different.…”

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confidence: 99%

Recognition and management of thrombosed type of aortic dissection with long-term follow-up results

Matsuo¹

2000

Int J Angiol

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Clotted false lumen: reappraisal of indications for medical management of acute aortic dissection.

Abstract: Evidence of a clotted false lumen in patients with acute aortic dissection has been considered to be a primary indication for medical rather than

Cited by 21 publications

References 7 publications

Long-Term Prognosis of Acute Aortic Dissection With Medical Treatment. A Survey of 263 Unoperated Patients.

Long-Term Prognosis of Acute Aortic Dissection With Medical Treatment. A Survey of 263 Unoperated Patients.

A Decade of Thoracic Endografting: Planning the Next 10 Years…

Recognition and management of thrombosed type of aortic dissection with long-term follow-up results

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