Abstract
Objectives: Treatment strategies for Stanford type A dissection with a thrombosed false lumen remain controversial, and whether surgery or conservative treatment should be performed is a matter of ongoing debate. In this study, we examined the treatment strategies for cases in which treatment was initiated conservatively at the onset. Methods: This study involved 20 patients with Stanford type A acute aortic dissection with a thrombosed false lumen treated between February 2002 and October 2010. We compared cases with indications for surgery at the onset or with conversion to surgery during the course of treatment to those not indicated for surgery until the remote phase. Results: The average diameter of the ascending aorta at the onset was 42.5±5.6 mm (range, 35–48) in the non-operative group and 49.3±4.8 mm (range, 40–60) in the operative group. The diameter was significantly larger in the operative group. There were significantly more cases with a site of entry or ulcer-like projection in the ascending aorta or aortic arch in the operative group. However, no significant difference was observed in the thickness of the false lumen between the 2 groups. Conclusion: Because surgical outcomes for re-dissection are poor, surgery should be aggressively performed in high-risk cases. In particular, semi-emergency surgery is necessary in patients with an ascending aorta diameter of 50 mm or more, or in whom there is an entry into the ascending aorta or aortic arch.
