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Acute type B aortic dissection complicated by visceral ischemia
Frederik H W Jonker1, Himanshu J Patel2, Gilbert R Upchurch3
1Thoracic Aortic Research Center, Policlinico San Donato, Italy; Department of Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
The Journal of Thoracic and Cardiovascular Surgery
|December 16, 2014
Summary
Patients with acute type B aortic dissection (ABAD) and visceral ischemia face high mortality. Endovascular repair and surgery show similar outcomes, while medical management predicts worse survival, highlighting the need for early intervention.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Aortic Diseases
Background:
- Acute type B aortic dissection (ABAD) can lead to visceral malperfusion.
- Visceral ischemia is a severe complication of ABAD with potentially life-threatening consequences.
Purpose of the Study:
- To investigate the clinical presentation, management strategies, and patient outcomes.
- To analyze outcomes of ABAD patients with visceral ischemia using data from the International Registry of Acute Aortic Dissection.
Main Methods:
- Retrospective analysis of 1456 ABAD patients from 1996-2013.
- Stratification of patients based on the presence of visceral ischemia at admission.
- Comparison of demographics, comorbidities, imaging, management, and outcomes between groups.
Main Results:
- 104 patients (7.1%) presented with visceral ischemia, showing higher rates of limb ischemia and renal failure.
- In-hospital mortality was significantly higher in the visceral ischemia group (30.8% vs 9.1%).
- Endovascular and surgical treatments yielded similar mortality rates; medical management independently predicted mortality.
Conclusions:
- Visceral ischemia in ABAD patients is associated with significantly increased mortality risk.
- Endovascular management and surgical repair offer comparable outcomes for visceral ischemia.
- Early diagnosis and prompt intervention are critical for improving survival in ABAD with visceral ischemia.
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