Outcome and quality of life in operated and non-operated acute aortic dissection type B

Objective: Treatment of acute aortic dissection type B (AADB) remains a matter of debate. Endovascular repair (EVAR) of the descending thoracic aorta may offers new therapeutic options for this pathology. We assessed early and long-term outcome and quality of life (QoL) of patients with AADB treated conservatively, surgically or with EVAR.

Methods and results: Between 01/00 and 12/05 86 patients were admitted with AADB. In-hospital data were assessed. QoL was analysed with the SF-36. Mean age was 63.2±10.3 years. 15 patients (17.4%) underwent surgical (n=3) or EVAR treatment (n=12). Mortality was 0%. 71 patients (82.6%) were treated medically. 4 (5.6%) died – in 3 surgery was refused, due to age (over 80 years), comorbidities and/or rupture. 1 patient (1.4%) treated medically, died from unexpected rupture. 5 patients underwent abdominal revascularization because of malperfusion syndrome. 11 patients (15.5%) required delayed surgery (average delay 308 days): 10 (90.9%) were treated by graft interposition and 1 underwent EVAR. Follow-up (average 36.1±19.2 months) showed excellent QoL in the medically treated collective and in patients with open graft interposition. EVAR patients scored lower in the aspect physical health.

Conclusion: Nowadays, AADB can be treated by conventional graft interposition or by EVAR with low mortality. Patients treated conservatively need a close follow-up to early detect visceral malperfusion which may require surgical revascularization and/or interventional fenestration or a secondary dilatation of the downstream aorta. QoL is excellent and similar with an age and gender-matched standard population. Surprisingly, patients after EVAR still have some limitations in physical health.