Abstract 17985: Natural History of Uncomplicated Stanford Type B Aortic Dissection and Intramural Hematoma
Background: Survivors of uncomplicated Stanford type-B aortic lesions treated with optimal medical therapy (OMT) are at high risk for aneurysm degeneration and late complications. The rate of false-lumen growth has practical and potentially prognostic implications. The purpose of this study was to evaluate the temporal evolution of aortic degeneration in patients with initially uncomplicated type-B aortic dissection (AD) and intramural hematoma (IMH).
Methods: A retrospective cohort of 136 patients with uncomplicated type-B AD (n=92) and IMH (n=44) treated with OMT was assembled from the databases of two aortic centers in the US and EU. Aortic diameters and growth-rates were determined using a dedicated 3D software and protocol by comparing follow-up scans to CT scans obtained at baseline (within 14 days). Adverse events (AE) - defined as rapid growth, aneurysm formation (≥6cm), organ ischemia, and fatal or non-fatal aortic rupture, were recorded.
Results: Rapid aortic growth with a diameter increase of ≥ 5 mm during the first 6 months of follow-up was associated with an increased risk of AE for AD (p< 0.001). In more than half of patients with IMH (59%), the lesion resolved completely within 12 months; in patients with non-resolving IMH, the median aortic growth was 1.49 mm/month (IQR: 0.11 - 2.79). Using Kaplan Meier analysis the 1-, 2- and 5-year event free survival of type-B AD were 84.3% (95% CI: 74.4 - 90.6), 75.4% (95% CI: 64.0 - 83.7) and 62.6% (95% CI: 68.9 - 73.6), respectively. The corresponding survival estimates for IMH were 76.5% (95% CI: 57.8 - 87.8), 76.5% (95% CI: 57.8 - 87.8) and 68.9% (95% CI: 45.2 - 83.9), respectively.
Conclusions: More than one third of patients with initially uncomplicated type B AD or IMH experience an AE within five years. Early rapid aortic growth is associated with increased risk for AE in type-B AD.
Author Disclosures: A.M. Sailer: None. P.J. Nelemans: None. S.M. van Kuijk: None. A.S. Chin: None. A. Kino: None. P. Chiu: None. M. Huining: None. M.P. Fischbein: None. M.D. Dake: None. D.C. Miller: None. G.W. Schurink: None. D. Fleischmann: Research Grant; Modest; Siemens Medical Solutions, General Electric. Ownership Interest; Modest; iSchemaView.
- © 2016 by American Heart Association, Inc.