XXXX after medical management of type B aortic dissections.

@entity1 @entity715 @entity439 @entity101
BACKGROUND: @entity1 with uncomplicated type B aortic dissections who are managed medically are at risk of aortic @entity439 over time. However, the effect of improvement in antihypertensive medications and stricter blood pressure control is unknown. The goal of this study was to determine the rate of @entity439 in a contemporary cohort of @entity1 with medically treated type B dissection. METHODS: Included were all @entity1 with acute uncomplicated type B aortic dissection who were initially managed medically between March 1999 and March 2011 and had follow-up axial imaging studies. Maximum aortic growth was calculated by comparing the initial imaging study to the most current scan or imaging obtained just before any aortic-related intervention. An increase of >= 5  mm was the threshold considered as aortic growth. Predictors of aortic @entity439 were determined using Cox proportional hazards models. RESULTS: We identified 200 @entity1 (61% @entity1 ) with medically managed acute type B dissections receiving multiple imaging studies. @entity1 were an average age of 63.4  years, and 75.5% had a history of @entity101 . Mean follow-up was 5.3  years (range, 0.1-14.7  years). Mean time between the initial and final imaging studies was 3.2  years (range, 0.1-12.9  years). At 5  years, only 51% were free from aortic growth. Fifty-six @entity1 (28%) required operative intervention (50 open, 6 endovascular repair) for @entity439 , and the actuarial 5-year freedom from intervention was 76%. After excluding five @entity1 (2.5%) with early rapid degeneration requiring intervention within the first 2  weeks, the mean rate of aortic growth was 12.3  mm/y for the total aortic diameter, 3.8  mm/y for the true lumen diameter, and 8.6  mm/y for the false lumen diameter. Only aortic diameter at index presentation >3.5  cm was a risk factor for future growth (odds ratio, 2.54; 95% confidence interval, 1.34-4.81; P  < .01). Complete @entity715 of the false lumen was protective against growth (odds ratio, 0.19; 95% confidence interval, 0.11-0.42; P  < .01). CONCLUSIONS: Although medical management of uncomplicated acute, type B aortic dissections has been the standard of care, at 5  years, a significant number of @entity1 will require operative intervention for @entity439 . Further studies of early intervention (eg, thoracic endovascular aortic repair) for type B aortic dissection to prevent late @entity439 formation are needed.
