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Development of New Acute Dissection in the Ascending Aorta after Type B Dissection: Intramural Hematoma is not Benign
Samuel S. Leake, BS, Harleen K. Sandhu, MD, Charles C. Miller, III, PhD, Rana O. Afifi, MD, Ali Azizzadeh, MD, Anthony L. Estrera, MD, Hazim J. Safi, MD, Kristofer M. Charlton-Ouw, MD.
The University of Texas at houston Medical School, Houston, TX, USA.
OBJECTIVES: Aortic dissection is a dynamic process that can extend distal to the entry tear or proximally in a retrograde fashion. We sought to determine associations for development of new acute type A aortic dissection (ATAD) after type B dissection (TBAD).
METHODS: We reviewed our aortic dissection database for cases of ATAD from 2002-2013 that had known TBAD. Imaging and intraoperative reports were used to determine presence of entry tear with dissection flap vs. intramural hematoma (IMH). Demographic and disease-related variables were analyzed.
RESULTS: Among 419 new cases of ATAD, we identified 16 (3.8%) patients with previous known TBAD. Presence of flap vs. IMH could be determined in 403/419 cases (96%). IMH was more common in patients with previous TBAD (56% vs. 13%, P<.001). Previous thoracic (6/16, 38%, P<.001) and abdominal aortic surgery (4/16, 25%, P=.004) were also more common. There were 2 cases each of open and endovascular repair of the descending thoracic aorta (Figure); and 2 cases of open thoracoabdominal aortic repair. On multivariate regression analysis, IMH and previous aortic surgery were associated with new ATAD (P<.004). In-hospital mortality after ATAD repair in TBAD patients occurred in 1/16 (6%).
CONCLUSIONS: Patients with IMH of the descending thoracic aorta may develop new dissection in the ascending aorta. Not surprisingly, in patients with TBAD and new ATAD there was an association with previous aortic surgery. Surveillance of the ascending aorta is mandatory in all patients with TBAD.
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