eMedicine Specialties > Thoracic Surgery > Vascular

Aortic Dissection: Follow-up

Author: Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: Apr 16, 2009

Outcome and Prognosis

Hospital-based mortality rates for aortic dissection are approximately 30%.

Patients with type A aortic dissection who undergo surgical treatment have a 30% mortality rate; patients who receive medical treatment have a mortality rate of 60%. Comorbidities and advanced aged can pose a contraindication to surgery in selected patients.

Medically treated patients with type B dissection have a 10% mortality rate; surgically treated patients with type B dissection have a 30% mortality rate.

Treated aortic dissection patients have a 60% 10-year survival rate. The mortality rate is influenced by the patient's clinical condition.

Future and Controversies

The aortic dissection mortality rate is still high despite advancements in diagnostic and therapeutic modalities.1,3 Ideally, researchers will devise a test that detects aortic dissection before severe complications develop, thus allowing early intervention and eventually reducing mortality rates.

The findings of the smooth muscle myosin heavy-chain assay are not elevated in persons with acute myocardial infarction or other nonaortic conditions of chest pain syndromes. The test's sensitivity and specificity are promising, and, in the future, a battery of tests will help determine a genetic predisposition to aortic dissection, including conditions such as Ehlers-Danlos syndrome and Marfan syndrome.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Sarath Reddy, MD; Oladayo Osinuga, MD; Ramachandra C Reddy, MD; Sateesh Kesari, MBBS, MD; and Ali Hmidi, MD, to the development and writing of this article.



More on Aortic Dissection

Overview: Aortic Dissection
Workup: Aortic Dissection
Treatment: Aortic Dissection
Follow-up: Aortic Dissection
Multimedia: Aortic Dissection
References
Further Reading
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References

  1. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. Feb 16 2000;283(7):897-903. [Medline].

  2. Isselbacher EM. Diseases of the Aorta. In: Braunwald E, Zipes DP, Libby P, eds. Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia, Pa: WB Saunders; 2001:1431-48.

  3. Patel PD, Arora RR. Pathophysiology, diagnosis, and management of aortic dissection. Ther Adv Cardiovasc Dis. Dec 2008;2(6):439-68. [Medline].

  4. The Gale Encyclopedia of Medicine. 3rd ed. Stamford, Conn: Gale; 2008.

  5. Niino T, Hata M, Sezai A, Yoshitake I, Unosawa S, Shimura K, et al. Optimal Clinical Pathway for the Patient With Type B Acute Aortic Dissection. Circ J. Dec 24 2008;[Medline].

  6. Spittell PC, Spittell JA, Joyce JW, et al. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clin Proc. Jul 1993;68(7):642-51. [Medline].

  7. Larson EW, Edwards WD. Risk factors for aortic dissection: a necropsy study of 161 cases. Am J Cardiol. Mar 1 1984;53(6):849-55. [Medline].

  8. Roberts WC. Aortic dissection: anatomy, consequences, and causes. Am Heart J. Feb 1981;101(2):195-214. [Medline].

  9. Cigarroa JE, Isselbacher EM, DeSanctis RW, Eagle KA. Diagnostic imaging in the evaluation of suspected aortic dissection. Old standards and new directions. N Engl J Med. Jan 7 1993;328(1):35-43. [Medline].

  10. Erbel R, Engberding R, Daniel W, et al. Echocardiography in diagnosis of aortic dissection. Lancet. Mar 4 1989;1(8636):457-61. [Medline].

  11. Meredith EL, Masani ND. Echocardiography in the emergency assessment of acute aortic syndromes. Eur J Echocardiogr. Jan 2009;10(1):i31-9. [Medline].

  12. Nienaber CA, von Kodolitsch Y, Nicolas V, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med. Jan 7 1993;328(1):1-9. [Medline].

  13. Nienaber CA, Spielmann RP, von Kodolitsch Y, et al. Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography. Circulation. Feb 1992;85(2):434-47. [Medline].

  14. Fann JI, Smith JA, Miller DC, et al. Surgical management of aortic dissection during a 30-year period. Circulation. Nov 1 1995;92(9 Suppl):II113-21. [Medline].

  15. Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med. May 20 1999;340(20):1546-52. [Medline].

  16. Glower DD, Fann JI, Speier RH, et al. Comparison of medical and surgical therapy for uncomplicated descending aortic dissection. Circulation. Nov 1990;82(5 Suppl):IV39-46. [Medline].

  17. Kato M, Bai H, Sato K, et al. Determining surgical indications for acute type B dissection based on enlargement of aortic diameter during the chronic phase. Circulation. Nov 1 1995;92(9 Suppl):II107-12. [Medline].

  18. Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med. May 20 1999;340(20):1539-45. [Medline].

  19. Kaya A, Heijmen RH, Rousseau H, Nienaber CA, Ehrlich M, Amabile P, et al. Emergency treatment of the thoracic aorta: results in 113 consecutive acute patients (the Talent Thoracic Retrospective Registry). Eur J Cardiothorac Surg. Dec 22 2008;[Medline].

  20. Kouchoukos NT, Dougenis D. Surgery of the thoracic aorta. N Engl J Med. Jun 26 1997;336(26):1876-88. [Medline].

  21. [Guideline] Mammen L, Yucel EK, Khan A, et al. American College of Radiology Appropriateness Criteria acute chest pain - suspected aortic dissection. 2008;[Full Text].

  22. Friedman WF, Silverman N. Congenital Heart Disease in Infancy and Childhood. In: Braunwald E, Zipes DP, Libby P, eds. Heart Disease: A Textbook of Cardiovascular Medicine. 6th ed. Philadelphia, Pa: WB Saunders; 2001:1546.

  23. Jimenez JC, Moore WS. A staged replacement of the entire aorta from the ascending arch to the hypogastric arteries using a hybrid approach. J Vasc Surg. Dec 2008;48(6):1593-6. [Medline].

  24. Ponton A, Garcia I, Arnaiz E, Bernal JM. Spontaneous re-expansion of a collapsed thoracic endoprosthesis: case report. J Vasc Surg. Dec 2008;48(6):1585-8. [Medline].

  25. Roe BB. Prevention of air embolism with intravascular carbon dioxide washout. J Thorac Cardiovasc Surg. Apr 1976;71(4):628-30. [Medline].

  26. Townsend CM, Beauchamp DR, Sabiston DC, et al, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 16th ed. Philadelphia, Pa: WB Saunders; 2001:1330-6.

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Keywords

aortic dissection, dissection of aorta, aortic tear, aorta dissection, aortic aneurysm, dissecting aneurysm, tear in the aortic wall, Stanford classification, DeBakey classification, aneurysm, aorta pictures, aorta treatment, Ehlers-Danlos syndrome, Turner syndrome, aortic dissection treatment, aortic dissection pictures, percutaneous transluminal coronary angioplasty, PTCA, coronary artery bypass grafting, CABG, atherosclerosis, Marfan syndrome, Marfan's syndrome, dissection of the aorta, cerebrovascular accident, coarctation of the aorta, aortic coarctation, hemothorax, hypertension, aortic trauma, aorta trauma, aortic wall dissection, sudden cardiac death, aortic rupture, ruptured aorta, aorta rupture, aortic wall rupture, aorta wall rupture, hemopericardium, tamponade, cardiac tamponade, dissecting aortic aneurysm, pleural effusion, aortic artery, aortic stent, syphilis, cocaine use, myocardial infarction, MI, syncopy, hemiparesis, hemiplegia, Horner syndrome, anxiety, orthopnea, dysphagia, dyspnea,hemoptysis, superior vena cava syndrome

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Contributor Information and Disclosures

Author

Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association
Disclosure: Nothing to disclose.

Medical Editor

Benson B Roe, MD, Emeritus Chief, Division of Cardiothoracic Surgery, Emeritus Professor, Department of Surgery, University of California at San Francisco Medical Center
Benson B Roe, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Thoracic Surgery, American College of Cardiology, American College of Surgeons, American Heart Association, American Medical Association, American Society for Artificial Internal Organs, American Surgical Association, California Medical Association, Society for Vascular Surgery, Society of Thoracic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Vincent Lopez Rowe, MD, Assistant Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, Association for Academic Surgery, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, and Society for Vascular Surgery
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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