Back to Search
Start Over
The incidence of delayed complications in acute type B aortic dissections is underestimated
- Source :
- Journal of vascular surgery. 68(2)
- Publication Year :
- 2017
-
Abstract
- Objective Acute type B aortic dissections (TBADs) can have immediate or delayed complications within the first 2 weeks. Because the majority of clinical series retrospectively categorized TBAD, the incidence and outcome of delayed complications in initially uncomplicated TBAD within the first 14 days are not well described. Methods We retrospectively analyzed 86 patients (78% male; age, 62.5 ± 13 years) with acute TBAD treated consecutively between January 2004 and May 2016 at a tertiary referral center. All TBADs were confirmed by computed tomography angiography (CTA) on admission, after 2 to 5 days, and after 10 to 14 days. Study end points were the incidence of immediate and delayed complications (aortic rupture, malperfusion, rapid aortic expansion >4 mm, pain or hypertension resistant to medical therapy) and in-hospital mortality. In addition, we looked at CTA-detected morphometric variables (maximum diameters of descending aorta, false lumen [FL], and primary entry tear; number of intimal tears; FL configuration; true lumen collapse; course of the dissection) and their association with delayed complications. Finally, we assessed treatment modalities and clinical outcomes. Results Of all TBADs, 22 (26%) presented with immediate complications (rupture, n = 11); 64 patients (74%) were initially assessed as having uncomplicated TBAD. Of these 64 patients, 24 (28% of all 86) suffered from delayed complications (malperfusion, n = 10; aortic rupture, n = 3; early expansion >4 mm, n = 8; refractory pain, n = 2; uncontrollable hypertension, n = 1) at a median interval of 7.1 (2-14) days after symptom onset. During the first 14 days, 40 patients (46%) remained uncomplicated. The CTA analysis revealed a significant association of initial thoracic aortic diameter ( P = .009), size of the primary entry tear ( P = .018), true lumen collapse ( P = .019), and partially thrombosed FL ( P = .019) with the occurrence of delayed complications within the first 14 days. Of the patients with delayed complications, 87.5% underwent surgery (90% thoracic endovascular aortic repair, 10% peripheral revascularization); 12.5% in this group died following aortic rupture before they received surgical repair. The mortality of patients with delayed complicated TBAD was significantly higher compared with those who remained uncomplicated within the 14-day period (12.5% vs 0%; P = .0221). Conclusions Delayed complications in initially uncomplicated acute TBAD are not infrequent. Morphologic variables like maximum diameter of the descending aorta, primary entry tear, true lumen collapse, and partially thrombosed FL were associated with an increased risk of delayed complications in initially uncomplicated TBAD. Future clinical research must verify the predictive role of clinical and morphologic variables in the acute phase, particularly with regard to a possible early surgical treatment to prevent a fatal outcome.
- Subjects :
- Male
medicine.medical_specialty
Aortography
Time Factors
Databases, Factual
Computed Tomography Angiography
medicine.medical_treatment
Aortic Rupture
Lumen (anatomy)
030204 cardiovascular system & hematology
Revascularization
Time-to-Treatment
03 medical and health sciences
Aortic aneurysm
0302 clinical medicine
Aneurysm
Risk Factors
medicine.artery
Germany
Medicine
Humans
030212 general & internal medicine
Hospital Mortality
Aortic rupture
Computed tomography angiography
Aged
Retrospective Studies
medicine.diagnostic_test
business.industry
Incidence
Endovascular Procedures
Middle Aged
medicine.disease
Surgery
Aortic Aneurysm
Aortic Dissection
Treatment Outcome
Descending aorta
Acute Disease
Hypertension
Disease Progression
Female
Cardiology and Cardiovascular Medicine
business
Vascular Surgical Procedures
Subjects
Details
- ISSN :
- 10976809
- Volume :
- 68
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Journal of vascular surgery
- Accession number :
- edsair.doi.dedup.....771222ef41f04967ee0a1bb237b46928