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(Circulation. 2006;114:I-384 – I-389.)
© 2006 American Heart Association, Inc.

Surgery for Aortic and Peripheral Vascular Disease

Outcomes of Medical Management of Acute Type B Aortic Dissection

Anthony L. Estrera, MD; Charles C. Miller, III, PhD; Hazim J. Safi, MD; Jennifer S. Goodrick, MS, RN; Arash Keyhani, MD; Eyal E. Porat, MD; Paul E. Achouh, MD; Riad Meada, MD; Ali Azizzadeh, MD; Jayesh Dhareshwar, MD; Adnan Allaham, MD

From the Department of Cardiothoracic and Vascular Surgery, The University of Texas–Houston Medical School, Memorial Hermann Heart and Vascular Institute, Houston, Tex.

Correspondence to Anthony L. Estrera, Department of Cardiothoracic and Vascular Surgery, The University of Texas–Houston Medical School, 6410 Fannin St, Suite 450, Houston, TX 77030. E-mail Anthony.l.estrera{at}uth.tmc.edu

Background— Currently, the optimal treatment of acute type B aortic dissection remains controversial. The purpose of this study was to report early clinical outcomes of medical management for acute type B aortic dissection.

Methods and Results— Between January 2001 and March 2005, 129 consecutive patients with the confirmed diagnosis of acute type B aortic dissection were studied. Mean age was 61 years (range, 29 to 94), with 33.3% (43/129) female. Acute type B aortic dissection protocol was instituted with the intent to manage all patients medically. Indications for surgical intervention included rupture, aortic expansion, malperfusion, and intractable pain. All patients were followed-up after discharge. Hospital mortality was 10.1% (13/129), 19% (4/21) when vascular intervention was required, and 8.3% (9/108) when medical management was maintained. Early intervention was required in 21 cases (16.2%), 19 (14.7%) open vascular/aortic cases and 2 cases (1.6%) of percutaneous aortic interventions. Morbidity included rupture (4.7%), stroke (4.7%), paraplegia (8.5%), bowel ischemia (7%), acute renal failure (21%), dialysis requirement (13%), and peripheral ischemia (4.7%). Late vascular-related procedures were performed in 5.2% (6/116) of cases. Univariate risk factors for early mortality were rupture (P<0.0001), need for laparotomy (P<0.008), acute renal failure (P<0.0001), need for dialysis (P<0.0001), and lower extremity ischemia (P<0.0004). The only independent risk factors for hospital mortality by multiple logistic regression was rupture (P<0.0009), and independent risk factors for midterm death were history of chronic obstructive pulmonary disease (P<0.002) and low glomerular filtration rate (<57 mL/min; P<0.0001).

Conclusions— Medical management for acute type B aortic dissection is associated acceptable outcomes. Outcomes of other management strategies, eg, endovascular stenting, for acute type B aortic dissection need to be compared with these results.

Key Words: aneurysm • aorta • aortic dissection • arteries • cerebral infarction • cerebral ischemia • complications • hypertension • stroke