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Significance of recurrent pain in acute type b aortic dissection

2001; Elsevier BV; Volume: 87; Issue: 7 Linguagem: Inglês

10.1016/s0002-9149(00)01545-9

1879-1913

James L. Januzzi, Herman D. Movsowitz, Julie C Choi, William B. Abernethy, Eric M. Isselbacher,

Aortic aneurysm repair treatments

Although it is currently believed that medical management with aggressive antihypertensive therapy is the treatment of choice for uncomplicated type B aortic dissection (AD), 1 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; 3: 1026-1034 Abstract Full Text PDF PubMed Scopus (198) Google Scholar , 2 Glower DD, Fann JI, Speier RH, Morrison L, White WD, Smith LR, Rankin JS, Miller DC, Wolfe WG. Comparison of medical and surgical therapy for uncomplicated descending aortic dissection. Circulation 1990;82(suppl IV):IV-39–IV-46. Google Scholar , 3 Glower D.D. Speier R.H. White W.D. Smith L.R. Rankin J.S. Wolfe W.G. Management and long-term outcome of aortic dissection. Ann Surg. 1991; 214: 31-41 Crossref PubMed Scopus (157) Google Scholar , 4 Masuda Y, Yamada Z, Morooka N, Watanabe S, Inagaki Y. Prognosis of patients with medically treated aortic dissections. Circulation 1991;84(suppl III):III-7–III-13. Google Scholar , 5 Elefteriades J.A. Hartleroad J. Gusberg R.J. Slazar A.M. Black H.R. Kopf G.S. Baldwin J.C. Hammond G.L. Long-term experience with descending aortic dissection the complication-specific approach. Ann Thorac Surg. 1992; 53: 11-21 Abstract Full Text PDF PubMed Scopus (220) Google Scholar , 6 Elefteriades J.A. Lovoulos C.J. Coady M.A. Tellides G. Kopf G.S. Rizzo J.A. Management of descending aortic dissection. Ann Thorac Surg. 1999; 67: 2002-2005 Abstract Full Text Full Text PDF PubMed Scopus (203) Google Scholar , 7 Wheat M.E. Palmer R.J. Bartley T.B. Seelman R.C. Treatment of dissecting aneurysm of the aorta without surgery. J Thorac Cardiovasc Surg. 1965; 50: 364-373 PubMed Google Scholar , 8 Daily P.O. Trueblood H.W. Stinson E.B. Wurflein R.D. Shumway N.E. Management of acute aortic dissections. Ann Thorac Surg. 1970; 10: 237-247 Abstract Full Text PDF PubMed Scopus (903) Google Scholar the indications for early aortic surgery in this setting remain poorly defined. Among the widely accepted complications of indicating a need for early surgery in the setting of acute type B AD is recurrent pain in the face of adequate medical therapy. 3 Glower D.D. Speier R.H. White W.D. Smith L.R. Rankin J.S. Wolfe W.G. Management and long-term outcome of aortic dissection. Ann Surg. 1991; 214: 31-41 Crossref PubMed Scopus (157) Google Scholar , 4 Masuda Y, Yamada Z, Morooka N, Watanabe S, Inagaki Y. Prognosis of patients with medically treated aortic dissections. Circulation 1991;84(suppl III):III-7–III-13. Google Scholar , 5 Elefteriades J.A. Hartleroad J. Gusberg R.J. Slazar A.M. Black H.R. Kopf G.S. Baldwin J.C. Hammond G.L. Long-term experience with descending aortic dissection the complication-specific approach. Ann Thorac Surg. 1992; 53: 11-21 Abstract Full Text PDF PubMed Scopus (220) Google Scholar , 6 Elefteriades J.A. Lovoulos C.J. Coady M.A. Tellides G. Kopf G.S. Rizzo J.A. Management of descending aortic dissection. Ann Thorac Surg. 1999; 67: 2002-2005 Abstract Full Text Full Text PDF PubMed Scopus (203) Google Scholar Although it has long been assumed that such pain may represent recurrent dissection or a warning of impending aortic rupture, no study has been performed to demonstrate the benefit of surgery for those with recurrent pain. We therefore set out to examine more closely the frequency of recurrent pain among patients with acute type B AD and to determine whether such symptoms were predictive of an adverse outcome compared with those without recurrent pain.