Abstract 2132: Acute Type B Aortic Dissection: Does Aortic Arch Involvement Affect Management and Outcomes? Insights From The International Registry of Acute Aortic Dissection (IRAD)
Background: Clinical profiles and outcomes of patients with acute type B aortic dissection with involvement of the aortic arch have not been well described.
Methods: We studied 527 consecutive patients classified with acute type B aortic dissection enrolled in IRAD from 1996 to 2003 to characterize the prevalence, presentation, management, and outcomes of patients with aortic arch involvement (AAI) compared to those without aortic arch involvement. AAI was defined by the involvement of the aortic arch by the type B dissection on cross-sectional imaging.
Results: 139 (26.4%) patients had AAI with an overall mean age of 64.0 years. Compared to the 388 (73.6%) patients with no AAI, patients with AAI were more likely to have a history of prior aortic dissection and prior aortic surgery. (Table⇓) On imaging, patients with AAI were more likely to have a widened mediastinum on chest x-ray and aortic regurgitation, however patients with AAI were less likely to develop renal failure as a complication of their dissection. There was no difference in in-hospital management or overall mortality, including mortality stratified by type of therapy.
Conclusions: There are several differences in the history, clinical course and imaging characteristics of patients with acute type B aortic dissection with and without aortic arch involvement. The implications of arch involvement for treatment or outcomes remain uncertain.