Abstract 2131: In Search For Optimal Treatment Of Complicated Acute Type B Aortic Dissections: Insights from The International Registry Of Aortic Dissection (IRAD)
BACKGROUND Aortic complications in acute type B aortic dissection (ABAD) are primary predictors of in-hospital outcome. Accordingly, we sought to evaluate the clinical features and results of treatment of patients presenting with complications, enrolled in the International Registry of Acute Aortic Dissection (IRAD).
METHODS: A comprehensive analysis of 290 clinical variables and their relation to in-hospital outcome of patients with complicated ABAD enrolled in IRAD from 1996–2004 was performed. Patients were defined as complicated (group I), in presence of shock, periaortic hematoma, spinal cord ischemia, mesenteric ischemia/infarction, acute renal failure, limb ischemia, recurrent pain, refractory pain or refractory hypertension. All other patients were categorized as uncomplicated (group II). In group I single complications with specific treatments were evaluated.
RESULTS: The overall in-hospital mortality in ABAD was 12.4 %. Mortality in group I (250 pts, 45.5%) was 20.0 %, compared to 6.1 in group II (300 pts 54.5%) (p<0.001). Univariate predictors of ABAD complications were Marfan syndrome, abrupt onset of pain, migrating pain, need for diagnostic examination with MRI and/or aortogram, abdominal vessel involvement at aortogram, descending aortic diameter > 6 cm, pleural effusion and widened mediastinum on CXR. In group I, in-hospital surgical and percutaneous intervention mortalities were 28.6% and 10.1% (p.006), respectively. Among specific complications, only recurrent pain had a significantly better result after placement of an aortic stent-graft (p<0.05). Most complications revealed a trend for lower mortality after stenting or fenestration, while mesenteric ischemia/infarction required surgery for better outcome.
CONCLUSIONS: In ABAD, specific complications determine hospital outcomes. Endovascular interventions are associated with better results than surgery, except in the presence of visceral ischemia. Whether this difference reflects selection bias favoring less ill patients receiving endovascular treatment, or the result of therapy, is not yet known.