Prognosis of Stanford Type B
Acute Aortic Dissection and Availability of Early Rehabilitation
Program in Medical Treatment |
Hitoshi Fukumoto |
Yasuhisa Nishimoto |
Masayoshi Nishimoto |
Toshihiko Ibaragi |
Shuuichi Suzuki |
Akira Fujiwara |
(Osaka Mishima Critical Care Medical Center, Takatsuki,
Japan)
|
Stanford type B acute aortic dissection
without complications has been considered to be an indication
for medical rather than surgical treatment. To investigate the
availability of medical treatment and early rehabilitation, we
evaluated 90 cases treated between 1986 and 1999 with type B
acute aortic dissection. These consisted of 79 nonruptured cases
and 11 ruptured cases at the beginning of treatment in our medical
center. No surgery was performed in any of the nonruptured cases
but surgery was performed in 8 of 11 ruptured cases. Surgical
mortality in the rupture type was 12.5% (1/8). During medical
treatment of the nonrupture type, 3 patients died of sudden rupture
(1 case) and bowel ischemia (2 cases). An early rehabilitation
program in which the goal was for the patient to walk around
the ward within 2 weeks was performed for 31 consecutive cases
of nonrupture type without vascular complications. Mortality
was not significantly different between the early and conventional
rehabilitation groups. The incidence of pneumonia and ICU syndrome
during medical treatment was 13.0% (6/46) and 37% (17/46), respectively
in the conventional group and 0% and 12.9% (4/31), respectively
in the early group. The incidence of ICU syndrome was significantly
lower in the early group than in the conventional group. Despite
the limitations of this study, medical treatment and early rehabilitation
showed good results in cases of uncomplicated type B acute aortic
dissection.
Jpn. J. Cardiovasc. Surg. 31:114-119(2002) |
|