Outlook of non operated type B aortic dissection with special reference to the incidence of degenerative abdominal aortic aneurysm (AAA). One center study

Objectives : to determine the value of pharmacological treatment of type B aortic dissection (B AD) in face of new forms of treatment. Design : this is a retrospective study of the period from 1990 to 2000. Files of 81 patients have been reviewed and completed by questionnaires. Results Two B AD died after admission without any treatment, 10 were operated on with 7 discharged alive (group 1) 69 received hypotensive agents and beta-blockers, 65 were discharged alive (group 11). Late mortality of the group I is 3/7, not related with B AD. Late mortality after mean follow-up of 56.8 months is 27/65 with 4/27 related to B AD (4 ruptures, 2 operated on). Non fatal secondary surgery amounts 5 in 4 patients. Total B AD aortic events comprise 8/65 patients. Type A AD were operated on successfully (8 : 4 before B AD, and 4 after B AD). Degenerative abdominal aortic aneurysms were present, operated (9) or not (3), in the history of patients and 3 more appear subsequently. At 10 years, actuarial survival is 40% +/- 18. Conclusion : in non-complicated cases of B AD, medical treatment is a reasonable choice, provided that a strict follow-up of the thoracic abdominal aorta is performed.