Treatment strategy based on the natural course of the disease for patients with spontaneous isolated abdominal aortic dissection

Abstract

Based on our observation, the majority of symptomatic and asymptomatic SIAAD patients can be managed conservatively unless they present with aortic rupture, concomitant large aortic aneurysm, or underlying connective tissue disease. However, a more proactive management strategy may be required for female, symptomatic patients or those with suprarenal SIAAD.

Systematic Review and Meta-analysis of Current Literature on Isolated Abdominal Aortic Dissection

“…2. During follow up, other than two deaths before treatment and 35 deaths in the Kang et al 13 study with non-separated data, 21 deaths The overall 91% of IAADs were spontaneous, which is comparable to previous studies reporting dissection types (66.7e100%). 3,7,9,11,14,18,19,21,25,26 Hypertension, smoking, and hyperlipidaemia were the most common concomitant risk factors of IAAD, which could induce endothelial damage and a persistent inflammatory response to stimulate formation of atherosclerosis and spontaneous aortic dissection.…”

“…1. Among the included studies, four were retrospective cohort studies 3,13,14,20 and the rest were case reports or case series. Ten studies reported different treatment strategies, including conservative treatment, ENDO and OS 3,7,8,10,13,15e18,26 ; six studies only reported ENDO 9,14,19e21,25 and one study only reported OS.…”

“…In pooled estimates, the 30 day mortality, the long term mortality, and the re-intervention rate during follow up were 3%, 8%, and 8%, respectively. To date, the largest retrospective study was conducted by Kang et al 13 including 210 patients, in which 13.3% of patients were symptomatic at initial presentation and the long term all cause mortality was 16.7%. However, aortic related deaths occurred in only 1.4% of patients.…”

“…This will result in aneurysmal degeneration of the outer wall and dissection related complications. 33,34 Kang et al 13 reported that only 1.4% of patients had complete remodelling of IAAD during CTA follow up, 81.9% with no change or remodelling, 8.7% with false lumen enlargement, and 6.5% with progression. As a consequence, AAA formation and symptomatic arterial insufficiency are the main reasons for clinical adverse events in patients initially treated conservatively.…”

“…3,7e 9,11,13e16,18e21,25 In the pooled result, 28% of patients suffered concomitant AAAs at the time of first admission, similar to other experiences. 3,7 Although the optimal size of dissection aneurysm for intervention remains poorly defined, some studies state that an abdominal aorta >5 cm diameter was the indication for intervention, 13,15,21,25 while other studies recommended that the threshold for intervention should probably be decreased to 3 cm because a dissecting aneurysm is more likely to rupture and need earlier intervention. 9,14,18e20 Therefore, more comparative studies investigating the optimal threshold for invasive intervention in patients with IAAD are needed in the future.…”