Fate of aorta and clinical outcomes in patients with chronic type B aortic dissection: over 20-year experience

Aim. In type B double-barrel aortic dissection (AD), the fate of the affected aorta, causes of death, and very long-term clinical outcomes have not been completely elucidated. The purpose of this study was to clarify the fate of the affected aorta and long-term clinical outcomes in patients with type B AD during the chronic phase. Methods. One hundred and four patients were entered into this study, and regular follow-up CT studies (mean; 87.6 months) were performed. Also, clinical data including AD-related events (including aneurysm formation, rupture, ischemia, and re-dissection), AD-related deaths, and long-term survival were retrospectively reviewed. Results. Forty-six of 104 patients (44.2%) had one more AD-related event during the follow-up period. The actuarial event-free rates for any AD-related events of all patients were 95 +/- 2%, 75 +/- 5%, 53 +/- 6%, and 13 +/- 7% at 1, 5, 10, and 20 years, respectively. Initial aortic diameter >= 40 mm and blood flow in the false lumen were significant risk factors for AD-related events in univariate and multivariate analysis. Conclusion. In type B chronic aortic dissection, the affected aortas have a high incidence of AD-related events during the follow-up period. Prophylactic surgery or endovascular treatment for patients at high risk may reduce the AD-related events.