Patients with initially uncomplicated acute type B aortic dissections (TBADs) may have delayed complications more frequently than typically thought, researchers reported in the Journal of Vascular Surgery.
Most clinical series retrospectively classify TBAD, the authors noted, which means that delayed complications in initially uncomplicated TBAD within the first two weeks are often not well described.
To further investigate, the authors retrospectively evaluated data from 86 patients (78% male) with acute TBAD who were treated consecutively between January 2014 and May 2016. Computed tomography angiography (CTA) was used to confirm TBADs upon admission, as well as after 2 to 5 days and after 10 to 14 days.
The study used several endpoints, including the incidence of immediate and delayed complications (aortic rupture, malperfusion, rapid aortic expansion >4 mm, pain or hypertension resistant to medical therapy) and in-hospital mortality. The authors also examined the link between delayed complications and CTA-detected morphometric variables such as maximum diameters of descending aorta, false lumen and primary entry tear; number of intimal tears; false lumen configuration; true lumen collapse; and course of the dissection. Treatment modalities and clinical outcomes were also analyzed.
Results showed that 26% (22 patients) presented with immediate complications, while 74% (64 patients) were at first classified as having uncomplicated TBAD. However, 24 of those 64 patients with uncomplicated TBAD eventually experienced delayed complications at a median of 7.1 days after the onset of symptoms. These complications included malperfusion, aortic rupture, early expansion, refractory pain, and uncontrollable hypertension.
According to the authors, the CTA analysis showed that initial thoracic aortic diameter, size of the primary entry tear, true lumen collapse, and partially thrombosed false lumen were significantly associated with the occurrence of delayed complications within the first 14 days.
Nearly 88% of patients with delayed complications underwent surgery, but 12.5% of patients in the group died after aortic rupture occurred before surgical repair. Patients with delayed complicated TBAD had significantly greater mortality (12.5%) than patients who were uncomplicated within the 14-day period (0% mortality).
“Delayed complications in initially uncomplicated acute TBAD are not infrequent,” the authors concluded. They added, “Future clinical research must verify the predictive role of clinical and morphologic variables in the acute phase, particularly with regard to a possible early surgical treatment to prevent a fatal outcome.”
Reutersberg B, Trenner M, Haller B, Geisbüsch S, Reeps C, Hans-Henning E. The incidence of delayed complications in acute type B aortic dissections is underestimated. 2018;68(2):356-363.