Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1991 Apr;213(4):356–368. doi: 10.1097/00000658-199104000-00011

Aortic dissection with the entrance tear in the descending thoracic aorta. Analysis of 40 necropsy patients.

C S Roberts 1, W C Roberts 1
PMCID: PMC1358355  PMID: 2009018

Abstract

Clinical and necropsy findings are described in 40 patients who had aortic dissection with the entrance tear in the descending thoracic aorta. Their ages at death ranged from 39 to 91 years (mean, 66 years); 24 (60%) were men and 16 (40%) were women. Systemic hypertension was present by history in 33 patients (83%) and the hearts were of increased weight in 78%. Of the 40 patients, 31 (78%) had no operative intervention, while 9 (22%) underwent operation for aortic dissection. Of the 31 patients without operative therapy, the diagnosis of aortic dissection was established in life in 9 patients (29%) and at necropsy in 22 (71%). The interval from aortic dissection to death was 30 days or less in 13 patients (42%); rupture of the false channel was the cause of death in 9 patients (69%), renal failure in 2 (15%), and the cause was unclear in 2 (15%). The interval from aortic dissection to death was more than 30 days in 18 (58%) of the 31 patients without operative therapy. The cause of death in these 18 patients was related to the dissection in 11 (61%) (rupture of the false channel in 5; renal failure from dissection in 3, and rupture of the false channel of a second acute dissection in 3), but in the other 7 patients (39%) death was unrelated to the dissection but a nonfatal complication, specifically stenosis of the true channel from compression by a thrombus-filled false channel, occurred in 4 of these 7 patients. Thus only 3 (10%) of the 31 patients without operative therapy had no complications of aortic dissection. All nine patients who underwent operation had had an aortic dissection within 30 days, and the operation was performed because of a major complication of the dissection. Four patients survived 8 to 84 months after the operation. Thus early operative intervention (before the appearance of complications) appears justified in patients with aortic dissection with the entrance tear in the descending thoracic aorta to prevent rupture of the false channel acutely or after initial healing; to prevent renal failure from compression of renal arteries by an aneurysmal false channel; to prevent true channel stenosis from compression by a thrombus-filled false channel; and possibly to prevent the recurrence of acute dissection.

Full text

PDF

Images in this article

359Fig. 1.
on p.359
360Fig. 2.
on p.360
360Fig. 3.
on p.360
361Figs. 4a-g.
on p.361
362Figs. 5a-c.
on p.362
362Fig. 6.
on p.362
363Figs. 7a-e.
on p.363
364Figs. 8a-f.
on p.364
365Fig. 9.
on p.365
365Figs. 10A and B.
on p.365
366Fig. 11.
on p.366
367Fig. 13.
on p.367

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Buja L. M., Ali N., Fletcher R. D., Roberts W. C. Stenosis of the right pulmonary artery: a complication of acute dissecting aneurysm of the ascending aorta. Am Heart J. 1972 Jan;83(1):89–92. doi: 10.1016/0002-8703(72)90110-x. [DOI] [PubMed] [Google Scholar]
  2. Crawford E. S., Svensson L. G., Coselli J. S., Safi H. J., Hess K. R. Aortic dissection and dissecting aortic aneurysms. Ann Surg. 1988 Sep;208(3):254–273. doi: 10.1097/00000658-198809000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Daily P. O., Trueblood H. W., Stinson E. B., Wuerflein R. D., Shumway N. E. Management of acute aortic dissections. Ann Thorac Surg. 1970 Sep;10(3):237–247. doi: 10.1016/s0003-4975(10)65594-4. [DOI] [PubMed] [Google Scholar]
  4. DeSanctis R. W., Doroghazi R. M., Austen W. G., Buckley M. J. Aortic dissection. N Engl J Med. 1987 Oct 22;317(17):1060–1067. doi: 10.1056/NEJM198710223171705. [DOI] [PubMed] [Google Scholar]
  5. Doroghazi R. M., Slater E. E., DeSanctis R. W., Buckley M. J., Austen W. G., Rosenthal S. Long-term survival of patients with treated aortic dissection. J Am Coll Cardiol. 1984 Apr;3(4):1026–1034. doi: 10.1016/s0735-1097(84)80363-0. [DOI] [PubMed] [Google Scholar]
  6. Ergin M. A., Galla J. D., Lansman S., Griepp R. B. Acute dissections of the aorta. Current surgical treatment. Surg Clin North Am. 1985 Jun;65(3):721–741. doi: 10.1016/s0039-6109(16)43646-7. [DOI] [PubMed] [Google Scholar]
  7. HIRST A. E., Jr, JOHNS V. J., Jr, KIME S. W., Jr Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958 Sep;37(3):217–279. doi: 10.1097/00005792-195809000-00003. [DOI] [PubMed] [Google Scholar]
  8. Larson E. W., Edwards W. D. Risk factors for aortic dissection: a necropsy study of 161 cases. Am J Cardiol. 1984 Mar 1;53(6):849–855. doi: 10.1016/0002-9149(84)90418-1. [DOI] [PubMed] [Google Scholar]
  9. McFarland J., Willerson J. T., Dinsmore R. E., Austen W. G., Buckley M. J., Sanders C. A., DeSanctis R. W. The medical treatment of dissecting aortic aneurysms. N Engl J Med. 1972 Jan 20;286(3):115–119. doi: 10.1056/NEJM197201202860301. [DOI] [PubMed] [Google Scholar]
  10. Miller D. C., Stinson E. B., Oyer P. E., Rossiter S. J., Reitz B. A., Griepp R. B., Shumway N. E. Operative treatment of aortic dissections. Experience with 125 patients over a sixteen-year period. J Thorac Cardiovasc Surg. 1979 Sep;78(3):365–382. [PubMed] [Google Scholar]
  11. Roberts W. C. Aortic dissection: anatomy, consequences, and causes. Am Heart J. 1981 Feb;101(2):195–214. doi: 10.1016/0002-8703(81)90666-9. [DOI] [PubMed] [Google Scholar]
  12. Roberts W. C., Satler L. F., Wallace R. B. Hemodynamic confirmation of peripheral pulmonary stenosis caused by aortic dissection. Am J Cardiol. 1989 Jun 1;63(18):1418–1420. doi: 10.1016/0002-9149(89)91063-1. [DOI] [PubMed] [Google Scholar]
  13. Sabiston D. C., Jr Management of dissecting aneurysms of the aorta. N Engl J Med. 1972 Jan 20;286(3):154–155. doi: 10.1056/NEJM197201202860309. [DOI] [PubMed] [Google Scholar]
  14. WHEAT M. W., Jr, PALMER R. F., BARTLEY T. D., SEELMAN R. C. TREATMENT OF DISSECTING ANEURYSMS OF THE AORTA WITHOUT SURGERY. J Thorac Cardiovasc Surg. 1965 Sep;50:364–373. [PubMed] [Google Scholar]
  15. Wheat M. W., Jr Acute dissection of the aorta. Cardiovasc Clin. 1987;17(3):241–262. [PubMed] [Google Scholar]
  16. Wheat M. W., Jr, Harris P. D., Malm J. R., Kaiser G., Bowman F. O., Jr, Palmer R. F. Acute dissecting aneurysms of the aorta. Treatment of results in 64 patients. J Thorac Cardiovasc Surg. 1969 Sep;58(3):344–351. [PubMed] [Google Scholar]
  17. Wilson S. K., Hutchins G. M. Aortic dissecting aneurysms: causative factors in 204 subjects. Arch Pathol Lab Med. 1982 Apr;106(4):175–180. [PubMed] [Google Scholar]
  18. Wolfe W. G., Moran J. F. The evolution of medical and surgical management of acute aortic dissection. Circulation. 1977 Oct;56(4 Pt 1):503–505. doi: 10.1161/01.cir.56.4.503. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES