Abstract 18628: Aortic Arch Dissection: Does it Matter in the Current Management of Type B?

Abstract

Introduction: Current guidelines report that arch involvement in aortic dissection requires open surgical repair. However, arch dissections are frequently managed with less invasive treatment when ascending aorta involvement is absent. The aim of this project is to clarify the importance of aortic arch involvement in such conditions, Methods: Patients with aortic arch dissection enrolled in IRAD from January 1, 1996 to May 1, 2012 were included in this analysis. Patient groups were defined based on the location of the entry tear and aortic extension: entry tear in the aortic arch with extension confined to the arch (group 1; n = 8), entry tear in the aortic arch with antegrade extension (group 2; n = 55) and entry tear in de descending or abdominal aorta with retrograde extension into the arch (group 3; n = 55). For this abstract, we analyzed the difference in therapies and outcome for these groups. Results: Compared with the other groups, isolated arch patients presented more frequent with syncope, an abrupt onset of pain and less frequent with posterior pain. Treatment differed among groups and most of the isolated arch patients were treated medically. One third of the Group 3 patients was managed endovascular, with excellent outcomes, with a total in-hospital mortality of 7.3% (p = .062). No differences in mortality were observed during follow-up. (p = .193) Conclusion: Aortic arch involvement in aortic dissection is diverse and our observations emphasize that open surgical repair may be not always indicated in all patients. Selective patients, based on entry tear and aortic extension, might benefit from less invasive treatment options, such as endovascular repair and medical therapy