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

Abstract

Background-In the treatment of type B acute aortic dissection without complications, better results are obtained if surgery is performed before enlargement of the aorta in patients who are predicted to show aortic enlargement and if drug-based treatment is continued for patients who are predicted to show no enlargement. The purpose of this study was to predict the acute-phase factors that may affect chronic-phase aortic enlargement by studying chronic-phase enlargement of dissections in patients without complications during the acute phase. Methods and Results-In 101 patients with type B acute dissection who had no complications, univariate and multivariate factor analyses were performed to determine the predictors for chronic-phase enlargement (Ն60 mm) of the dissected aorta. The independent predominant predictors for aortic enlargement in the chronic phase were a maximum aortic diameter of Ն40 mm and a patent false lumen during the acute phase. The values of actuarial freedom from aortic enlargement for the patients with a maximum aortic diameter of 40 mm and a patent false lumen at 1, 5, and 10 years were 43%, 33%, and 22%, respectively, whereas in patients with a maximum aortic diameter of Ͻ40 mm and a closed false lumen, the values were 97%, 94%, and 84%, respectively. Conclusions-These results suggest that patients with type B acute aortic dissection who show a maximum aortic diameter of Ն40 mm and a patent false lumen should undergo surgery earlier during the chronic phase before enlargement of aorta, whereas patients with a maximum aortic diameter of Ͻ40 mm and a closed false lumen should continue to receive hypotensive therapy.

Growth Rate of Aortic Diameter in Patients With Type B Aortic Dissection During the Chronic Phase

“…COPD indicates chronic obstructive pulmonary disease; BP, blood pressure. 12 Although the results in these 2 articles were different, our results support the latter. In this study, the presence of COPD was not a significant risk factor for increase in the diameter in the univariate or multivariate analysis (Table 2).…”

“…6,7,12,14,15 These results can be explained by the La Place Law. 4,6 It states that the perpendicular stress on a cylinder is directly proportional to the pressure exerted by the fluid contents and its radius and is inversely proportional to wall thickness.…”

“…10,12 Medical and surgical treatment strategies are used in different populations. Usually, medical treatment is selected for patients with uncomplicated type B AD, and surgical treatment is selected for patients with complicated type B AD.…”

Mid-Term Outcomes of Acute Type B Aortic Dissection in Japan Single Center

“…Several studies have reported that patent false lumen is an important prognostic factor in patients with aortic dissection. [10][11][12] Early death occurred in 5 patients (3.9%) in the thrombosed group and 6 (5.9%) in the patent group. This difference was not significant.…”

“…[7][8][9] Several studies have reported that early or late complications such as aortic rupture and organ ischemia are related to whether the false lumen has been thrombosed or remains patent. 10,11) Akutsu, et al reported that a patent false lumen is strongly associated with late aortic events and mortality. 12) However there are few reports focusing on the false lumen of acute type B dissection in relation to early and late outcomes.…”