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Aortic arch involvement worsens the prognosis of type B aortic dissections

R James Valentine1, Julia M Boll1, Kyle M Hocking2

  • 1Department of Surgery, Vanderbilt University Medical Center, Nashville, Tenn.

Journal of Vascular Surgery
|July 12, 2016
PubMed

Insights

Acute aortic dissections involving the aortic arch (AD-arch) carry higher risks of complications and death than those limited to the descending aorta (AD-desc). Medical management is a safe initial treatment for AD-arch, but requires awareness of potential complications.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Aortic Disease
  • Aortic Dissection Management

Background:

  • Medical management of descending thoracic aortic dissections (AD-desc) yields acceptable outcomes.
  • The risk of retrograde extension and complications in acute aortic dissections involving the aortic arch (AD-arch) remains unclear compared to AD-desc.

Purpose of the Study:

  • To compare the outcomes of medically managed AD-arch dissections with AD-desc dissections.
  • To evaluate the risk of retrograde extension into the ascending aorta for AD-arch dissections.

Main Methods:

  • Retrospective analysis of 99 consecutive patients with acute aortic dissections not involving the ascending aorta (2005-2014).
  • Primary endpoints included dissection-related death and operative intervention.
  • Patients were categorized into AD-arch (n=20) and AD-desc (n=79) groups.

Main Results:

  • AD-arch dissections were associated with younger patients, higher rates of early intervention (40% vs 19%), cardiac complications (35% vs 11%), neurologic events (25% vs 6%), and dissection-related death (35% vs 11%) compared to AD-desc.
  • Proximal extension into the ascending aorta was rare (one patient with Marfan disease).
  • Arch involvement was the sole predictor of dissection-related death (OR 4.2) and medical treatment failure (OR 7.7).

Conclusions:

  • AD-arch dissections present a significantly higher risk profile, including adverse events and mortality, than AD-desc dissections.
  • Medical management is a safe initial approach for AD-arch, with rare proximal extension into the ascending aorta.
  • Clinicians must remain vigilant for increased complication risks and potential urgent interventions in AD-arch patients.
Abstract

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