S2: SVS Plenary Session II
Room to Come 1:20 – 2:30 p.m. uBallroom A/B, Level 3
At the end of this session, participants should be able to: 1. Discuss the methodology, results and conclusions of the research presented in vascular health. 2. Identify new technology for diagnosis and treatment of vascular disease. Moderators: Peter F. Lawrence, MD, UCLA Medical Center, Los Angeles, Calif. Manish Mehta, MD, The Institute for Vascular Health and Disease, Albany Medical College, Albany, N.Y.
SS6. Natural History of Medically-Managed Acute Type B Aortic Dissections
1:20 p.m.
Christopher A. Durham, Linda Wang, Emel A. Ergul, Nathan J. Aranson, Virendra I. Patel, Richard P. Cambria, Mark F. Conrad. Massachusetts General Hospital, Boston, Mass. OBJECTIVES: Although medical management of uncomplicated acute Type B aortic dissections remains the standard of care, contemporary data regarding the natural history of medically treated patients are sparse. The goal of this study is to evaluate the ability of medical therapy to prevent long-term complications in patients with acute Type B aortic dissection. METHODS: All patients with acute uncomplicated Type B aortic dissection that were initially managed medically between March 1999-March 2011 were included. Failure of medical therapy was defined as any death or aortic-related intervention. Early failure occurred within 15 days of presentation and late failure occurred thereafter. Predictors of long-term outcomes were determined using Cox Proportional hazards models. RESULTS: A total of 298 patients with medically managed acute Type B dissections were identified. The cohort had an average age of 65.9 years at presentation and was 61.7% male. There were 37 (12%) early failures including 12 deaths and 25 interventions (10 TEVAR/15 open). Aneurysmal degeneration was the indication for intervention in 6 (24%). Mean follow-up was 4.2 years (range 0.1-14.7 years). There were 174 (58.4%) failures including 87 deaths and 87 interventions (24 TEVAR/63 open). 57 (66%) interventions were for aneurysmal degeneration. Freedom from intervention was 77.3%+/0.024 at 3 years and 74.2%+/-0.025 at 6 years. There were no predictors of freedom from intervention. The intervention free survival was 55.0%+/-0.030 at 3 years and 41.0%+/-0.032 at 6 years. Age >70 years was protective against failure (HR .97, CI .95-.98, p<.01). Survival was higher in patients who required intervention at both 3 years (78% vs. 73%) and 6 years (76% vs. 58%)(p=0.018). CONCLUSIONS: Medical therapy of acute uncomplicated type B dissections is successful in the short term. However, the overall 6-year intervention free survival is low, and survival is significantly higher in patients who underwent intervention. AUTHOR DISCLOSURES: N.J. Aranson: Nothing to disclose; R.P. Cambria: Nothing to disclose; M.F. Conrad: Nothing to disclose; C.A. Durham: Nothing to disclose; E.A. Ergul: Nothing to disclose; V.I. Patel: Nothing to disclose; L. Wang: Nothing to disclose.
Vascular Annual Meeting 2014 • June 5 – 7, 2014 • Boston, Massachusetts
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