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Distinction between acute and chronic type B aortic dissection: is there a sub-acute phase?
1Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden. joste@live.se
Summary
Thoracic endovascular aortic repair (TEVAR) shows low mortality for acute complicated type B aortic dissection. A sub-acute phase exists beyond 14 days, challenging current definitions.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Diseases
Background:
- Acute complicated type B aortic dissection requires timely intervention.
- Current definitions may not fully capture the temporal spectrum of the disease.
Purpose of the Study:
- To evaluate the definition of acute dissection.
- To identify a potential sub-acute phase.
- To determine early outcomes of thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection.
Main Methods:
- A dual-centre consecutive case series of 102 patients undergoing TEVAR for acute complicated type B aortic dissection (1999-2011).
- Inclusion of 22 patients treated for dissection-related complications occurring >14 days post-symptom onset.
- Prospective data collection and follow-up until January 2012.
Main Results:
- No early deaths or neurological complications were observed in the 22 sub-acute patients (18%).
- Rapid aortic enlargement was the primary complication in the sub-acute group; rupture was more common in those treated within 14 days.
- Overall early mortality was 7%, with 2% paraplegia and 5% stroke rates.
Conclusions:
- TEVAR offers low early mortality and minimal neurological complications for acute complicated type B aortic dissection.
- A significant patient subset presents with complications >14 days post-onset, suggesting a sub-acute phase.
- The current definition of acute dissection may need re-evaluation.
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