[Aortic dissection. A 8-year material from health region 5]. / Aortadisseksjoner. Et åtteårsmateriale fra helseregion 5.

At the University Clinic Tromsø 27 and 16 patients with aortic dissection of Stanford type A and B have been admitted during the last eight years. The treatment strategy has been immediate surgery for type A and a conservative strategy consisting of blood pressure reduction and observation for type B. Nine (33%) of the patients with type A dissections were diagnosed either too late for surgery or at autopsy. Two were deemed too ill for operative treatment. One patient with a chronic type A dissection has been followed up without surgery. The remaining 15 were operated on. Four of these (26%) died within 30 days. Apart from a temporary hemiparesis, no sequelae related to the surgical treatment were observed in the remaining 11 patients. Six of the 16 patients with type B dissections were operated on because of organ ischemia or rupture/threatening rupture. Two died within 30 days. One patient had a prolonged postoperative course owing to multiple organ failure and muscle necrosis. Two of the ten patients with type B dissections who were followed up without surgery died during the observation period. These observations indicate a need for a more aggressive approach to the diagnosis and follow-up of aortic dissections.

Survival in thoracic or thoracoabdominal aortic aneurysm. Comparison between patients with or without surgical treatment.

The surgical mortality among 22 patients treated for thoracic or thoracoabdominal aneurysm was compared with the mortality in 47 patients managed without surgery. Surgical mortality ( < 30 days) was low (1/13) in ascending aortic aneurysm, but higher (3/8) in aneurysm of the descending or thoracoabdominal aorta (including both acute and elective operations). Of the 20 non-surgically managed patients in the latter group, 15 died after a mean of 1.1 year. The only patient operated on for aortic arch aneurysm died of cerebral ischaemia 2 days postoperatively. Most of the 19 non-operated patients with aneurysm of the arch or total aorta (mean age 76 years) were never considered for surgical treatment. The analysis supports aggressive management of patients with aneurysm of the ascending, descending or thoracoabdominal aorta. Many of our patients with aneurysm of the arch or involving most of the aorta were old and had other, concomitant diseases, and in such cases an aggressive treatment strategy does not seem justified.