| Strategy for Stanford Type A
Acute Aortic Dissection with Thrombosed False Lumen of the Ascending
Aorta |
(Department of Cardiovascular Surgery, Himeji Brain
and Heart Center, Hyogo, Japan)
| Hidefumi Obo |
Tsutomu Shida |
Syuuichi Kozawa |
| Tatsurou Asada |
Nobuhiko Mukohara |
Tetsuya Higami |
| Kazuhiko Iwahashi |
Teruo Yamashita |
Kyouichi Ogawa |
|
From 1995 till 1998, 21 cases of
Stanford type A dissecting aortic aneurysm with a closed false
lumen of the ascending aorta were treated in our institute. The
patients were medically treated if the diameter of their ascending
aorta stayed less than 50mm without recurrent dissection. Patients
were categorized into three groups: Groups I, II and IIIR (retrograde
dissection), according to the location of the entry analyzed
by means of CT, angiography and operative findings. Seven cases
of intramural hematoma (IMH) were included in this study. One
case in Group II died of rupture and one case in Group IIIR died
of multiple embolism caused by atrial fibrillation in the acute
phase. One case in Group II died of stroke and one case in Group
I died after surgery in the chronic phase. Four cases in Group
I and II underwent surgery in the acute phase and five cases
in Group I and II underwent surgery in the chronic phase, but
only one case of Group IIIR required surgery. Six cases of IMH
required surgery. The rates of freedom from operation at four
years was 25%, 21% and 83% respectively (p＝0.07). Essentially,
Stanford type A dissection should be treated surgically even
though the false lumen is thrombosed. However, in the case of
retrograde dissection accompanied by an entry in the descending
aorta, medical treatment may be a strategy option.
Jpn. J. Cardiovasc. Surg. 30: 280-284 (2001) |
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