Partial Thrombosis of the False Lumen in Patients with Acute Type B Aortic Dissection

Abstract

Mortality is high after discharge from the hospital among patients with type B acute aortic dissection. Partial thrombosis of the false lumen, as compared with complete patency, is a significant independent predictor of postdischarge mortality in these patients.

False Lumen Status in Patients With Acute Aortic Dissection: A Systematic Review and Meta‐Analysis

“…Our meta‐analysis indicated that partial false lumen thrombosis is not predictive of a greater risk of long‐term death in AAD type A; however, in the subgroup of Asian studies having a sample size <200, and a follow‐up <5 years, partial false lumen thrombosis was an independent predictor of poor long‐term survival in type A cases. For type B AAD, the IRAD data and our meta‐analysis have both shown that partial thrombosis of the false lumen, as compared with complete patency, is a significant independent predictor of long‐term postdischarge mortality in type B patients 20. On the contrary, 2 other studies29, 30 have suggested that the false lumen status does not influence long‐term mortality in type B AAD.…”

“…Four studies17, 22, 26, 27 examined the association between the false lumen status and AAD outcomes in type A patients, and another 6 studies18, 19, 20, 28, 29, 30 examined associations in type B patients. One study21 included both type A (73%) and type B (27%) AAD; in subgroup analysis based on the Stanford classification, this study was placed in the type A group.…”

“…Six studies7, 20, 26, 27, 29, 30 observed that partial thrombosis of the false lumen, when compared to completely patent false lumen, was an independent predictor of long‐term mortality (n=1308; HR, 2.06; 95% CI, 1.38–3.06; P =0.012) without significant heterogeneity (I 2 =41.7%; P =0.127). For type A studies,22, 26, 27 the pooled HR for long‐term mortality with partial thrombosis of the false lumen was 1.75 (95% CI, 0.88–3.45; P =0.211; Figure 3) with moderate heterogeneity (I 2 =68.1%; P =0.044).…”

“…Residual patency of the false lumen in AAD has been associated with aortic expansion and death, whereas patients with complete thrombosis of the false lumen have shown improved outcomes 17, 18, 19. In addition, the IRAD data have shown that partial thrombosis, defined as the concurrent presence of both flow and thrombus, is associated with a higher 3‐year mortality rate than a completely patent false lumen in patients with type B AAD 20. This conclusion supports the concept that a wide surgical extent during initial repair could decrease late mortality rates for AAD type A patients.…”

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

“…In addition, the D‐dimer concentration is reported to be lower in patients with a thrombosed false lumen (FL) or intramural hematoma than in patients with patent‐type AAD (ie, AAD with a patent FL) 12, 15. Status of the FL has recently attracted attention as a predictor of late outcomes not only in patients with acute type B aortic dissection16, 17 but also in patients who undergo urgent aortic repair for ATAAD 18, 19. However, the relation between status of the FL, particularly partial thrombosis of the FL, and the D‐dimer concentration in patients with AAD is poorly understood.…”