Recognition and management of thrombosed type of aortic dissection with long-term follow-up results

Abstract

In a previous report we have stated that two distinct types of aortic dissection exist, namely the opened-communicated type (O-type) which demonstrates communication between the true lumen and the false lumen, and the thrombosed type (T-type, also known as aortic dissecting hematoma or as intramural hematoma). The latter, in its acute phase, shows no opacification of the false lumen through medical imagings such as CT scans or angiography. In previous studies we analyzed the long-term follow-up results of consecutive patients with aortic dissections at our hospital.

During the past 14 years a study has been conducted of a total of 466 consecutive patients including 371 who were classified O-type and 95 who were classified as T-type. In 18 T-type patients (19%), complications such as cerebral ischemic episodes were observed. These were, however, transient and not serious, sometimes indicating only minor surgery. Only three T-type patients were indicated for surgery in the follow-up period, two because of the extension of a protruded lesion, and one because of the occurrence of redissection. Three of these died, but the actuarial survival rate of the T-type group was significantly higher than that of the O-type group. In conclusion, it can be stated that at the acute phase, a differentiation between the two types of dissection, ie, T-type and O-type, is important in the deciding of treatment.