Clinical features and prognosis in dissecting aneurysm of the aorta. A re-appraisal.

Abstract

The records of 62 patients on whom the diagnosis of aortic dissection was proved are reviewed with particular attention to the clinical features and prognosis in each case. This was the consecutive experience of a large general hospital over approximately 17 years. The initial and long-term survival was far better in patients in whom the ascending aorta was spared by the disease process. No patients in whom such involvement was present were known to survive more than 3 weeks. Eight of 19 patients whose disease began distal to the arch of the aorta are known to have survived 6 to 69 months even though six of these eight were not operated on. Striking differences in the clinical findings of the two groups were also found. Aortic regurgitation, impairment of a radial or carotid pulse, neurological signs, and hypotension were rare in the group whose dissection began beyond the left subclavian artery. Marked systemic hypertension was frequently observed in this group, over a third having a diastolic pressure over 140 mm Hg and nearly two thirds over 120 mm Hg. Such hypertension was unusual when the ascending aorta was the origin of the disease. Despite the present study the available data do not allow any definite conclusions about the efficacy of any form of therapy of this disorder.