Treatment of acute aortic dissection complicated by atherosclerotic aorticaneurysm

This study was designed to clarify the clinical characteristics and optimal management of patients who have acute aortic dissections accompanied by at herosclerotic (true) aortic aneurysm. Between January 1992 and August 1996, a total of 132 patients (Stanford type A/B = 72/60) had surgical repair or medical treatment of acute aortic dissection at our institution. Seventeen (type A/B: 5/12) of them had concurrent or previously repaired true thorac ic or abdominal aortic aneurysms. There were 14 men and three women patient s, ranging in age from 58 to 79 years with a mean of 70 years. Five patient s developed type A dissections that affected preexisting true aneurysms loc ated on the aortic arch (n=four) and infrarenal aorta (n=one). They all und erwent emergency operations: four patients had total arch repair with resec tion of aortic arch aneurysms resulting in one death due to myocardial infa rction, and the remaining one patient had a hemiarch repair that was follow ed by resection of an enlarged abdominal aortic aneurysm (AAA) 2 years late r. Twelve patients developed type B dissections. Five of them had preexisti ng true aneurysms affected by dissection: there were three descending thora cic aortic aneurysms (DTAA) and two AAAs; rupture occurred in three patient s (DTAA/AAA=one/two) while awaiting surgery. The other two patients success fully underwent emergency graft replacements of the descending thoracic aor ta containing true aneurysm and dissection. No patient among the remaining seven with type B dissections, who had AAAs not affected by dissection, had an unfavorable outcome because of the presence of concurrent dissection an d true aneurysm. The risk of rupture appears to be high in patients with an aortic segment where true aneurysm is affected by acute dissection. Hence, surgical repairs should be done on an emergency basis in those patients ir respective of the type of dissection.