Acute type B aortic dissection carries significant morbidity and mortality, requiring continual surveillance even in stable, medically managed patients to prevent late complications.
Supports continued surveillance in stable type B aortic dissection; leaves open optimal strategies to improve long-term survival.
Despite having a better survival prognosis than acute dissection of the ascending aorta (type A), acute type B aortic dissection sparing the ascending aorta is associated with substantial morbidity and mortality. Even for initially stable patients, the mortality rate is close to 9.6%, with the most common cause of death being sudden rupture or end-organ malperfusion. 1 The timing of these complications is very variable and unpredictable. From the International Registry of Acute Aortic Dissection (IRAD), involving 498 patients, Tsai and colleagues 2 showed that arch involvement (127/498, 25.5%) is not associated with higher follow-up mortality, provided blood pressure control is meticulous. Long-term survival in medically managed patients is estimated to be approximately 80% at 1 year, 72% at 3 years, and 58%–76% at 5 years. 3,4 Overall, of those who remain stable and asymptomatic, 70% will not require any future surgical intervention, but continual surveillance to prevent late complications such as aneurysmal dilatation is important. 5
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Chan et al. (2008) studied this question.
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