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Aortic Dissection

Monitoring

  • After hospitalization, patients treated both medically and surgically require close outpatient follow-up with monitoring of blood pressure.
    • Goal: Maintain systolic blood pressure at ≤ 120 mmHg.
  • Patients with chronic type B dissection and intramural hematomas should be followed on an outpatient basis every 6–12 months by contrast-enhanced CT or MRI to detect propagation or expansion.

Complications

  • Redissection
  • Acute aortic regurgitation
  • False aneurysm formation or rupture into:
    • Left pleural space
    • Retroperitoneum
    • Pericardium
    • Abdominal cavity
  • Aneurysmal dilatation [5]
    • The upper descending thoracic aorta is the major site of late aneurysmal dilation.
    • A large upper descending thoracic aorta false lumen diameter on the initial CT portends late aneurysm and adverse outcome warranting early intervention.
  • End-organ ischemia due to involvement of major branches of the aorta
    • MI
    • Stroke
    • Bowel ischemia
    • Renal failure
  • Hemopericardium
  • Cardiac tamponade
  • Superior vena cava syndrome
  • Horner’s syndrome
  • Airway compromise
  • Major causes of perioperative mortality and morbidity
    • MI
    • Paraplegia
    • Renal failure
    • Tamponade
    • Hemorrhage
    • Sepsis

Prognosis

  • Medically treated type A dissection
    • About 33% of patients die within the first 24 hours.
    • 50% die within 48 hours.
    • The 2-week mortality rate approaches 75%.
  • Medically treated patients (type B dissection)
    • In-hospital mortality rate: 10–20%
  • Surgically treated patients (type A or complicated type B dissection)
    • In-hospital mortality rate: 15–25%
  • Long-term prognosis for patients with treated dissections is generally good with careful follow-up.
    • 10-year survival rate: ~60%
  • Factors associated with increased in-hospital mortality and poor outcomes[1]
    • Age > 70 years
    • Shock on presentation
    • Branch vessel occlusion resulting in myocardial ischemia or visceral ischemia

Prevention

  • Treatment of risk factors may be preventative.
    • Control hypertension.
    • Control hyperlipidemia (atherosclerosis).

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Last updated: September 20, 2009
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