Current status of medical therapy of acute dissecting aneurysms of the aorta

Abstract

In 6 series of patients with acute dissecting aneurysms of the aorta reported during 1970-1979, the best results were obtained by intensive drug therapy initially to correct hypertension and stabilize the patient, then diagnosis by aortography, and then surgical repair for Type A aneurysms involving the ascending aorta, and drug therapy alone for Type B aneurysms involving the descending thoracic aorta. Using this plan of treatment, mortality rates were 30% in patients with Type A dissections (surgical therapy) and 20% in those with Type B dissections (drug thera-PY).

Toward the Best Treatment for Uncomplicated Patients With Type B Acute Aortic Dissection : A Consideration for Sound Surgical Indication

“…6 -8 The recommendations at several institutions are that surgical treatment be offered for all patients during the acute phase because the prevention of aortic rupture and organ ischemia through acute-phase surgery contributes to a better mortality or morbidity rate and because a number of patients with medically treated dissection have subsequent aortic enlargement and must undergo surgical treatment during the chronic phase. 4,8,10,12,13,18 In addition, the surgical results for these chronic-phase cases of enlarged aorta are definitely not better than the results for acute-phase surgery because more extended surgery and concomitant reconstruction of visceral arteries and the narrowed true lumen are necessary, and because respiratory complications due to severe adhesion of the lung occur during most of these operations in patients in the chronic phase. 9,16,17 However, surgical intervention must not be performed too prematurely in patients who have a low probability of aortic enlargement, because early surgery could be a cause of in-hospital death.…”

“…Recently, however, it was advocated that patients who had type B acute aortic dissection without complications, such as rupture or organ ischemia, be treated with hypotensive drugs during the acute phase, because the mortality rate with this treatment is reported to be equal to or slightly better than that for surgical treatment during the acute phase. 4,5,[12][13][14][15][16][17] Surgical treatment should be selected if the aortic diameter becomes enlarged during the chronic phase; careful observation of aortic enlargement in all patients treated during the chronic phase is very important but very difficult. Unfortunately, some patients who have successfully gone through the acute phase with medical hypotensive therapy suddenly die during the chronic phase of aortic rupture; ideally, enlargement of the aorta should be predicted and surgery should be performed early, before the aorta becomes enlarged.…”

Usefulness of transesophageal echocardiography in assessment of aortic dissection.

“…(10) DeBakey type 11 (1) DeBakey type III (1) No evidence of dissection (2) Not done (4) DeBakey type II aortic dissection proven bv DeBakev type III (8) DeBakey type IlI (6) aortoaraphv and cor surgerv (8) No evidence of dissection (1) Not done (1) CT. computed tomography: TEE, transesophageal echocardiographv.…”

“…Communications between the perfusing and nonperfusing lumens were identified if bright mosaic color flow signals were seen traversing from one lumen to the other through a consistent discontinuity or an apparently intact flap, often with an area of localized flow acceleration at its origin.18 An intra-aortic thrombus was diagnosed if a bright echo density within the aorta was consistently seen in a segment of the aorta and completely or incompletely occupied the nonperfusing lumen.17 (2) Dissection not present (7) CT scan not done (20) Dissection flap not seen (27) Ca, computed tomography; TEE, transesophageal echocardiography. In all patients undergoing intraoperative transesophageal echocardiography, additional recordings were obtained in the postbypass period to assess the aortic and/or coronary artery grafts.…”

Endovascular Stent Grafting for Thoracic Aneurysms in Jehovah?s Witnesses: Report of Three Cases

“…[6][7][8] Acute type-B aortic dissection is usually treated medically with vasodilators and -blockers; however, aneurysmal dilatation of the dissected aorta eventually occurs in 14%-20% of these patients. 9 Aneurysmal enlargement in the chronic phase of dissection is concerning because it necessitates the use of extended graft replacement for thoracic and thoracoabdominal lesions. Although the surgical results of these procedures have improved remarkably, mortality and morbidity remain high.…”