Management of Dissecting Aneurysms of the Aorta

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Abstract
During the last 20-year-period 42 patients with dissecting aortic aneurysms were treated at this hospital. The ascending aorta was involved in 23 patients, while 19 aneurysms were localized to the descending aorta. Ascending aneurysms were operated upon with an early mortality rate of 35%. A re-entry procedure via an abdominal incision was performed in one patient. Graft replacement and aortic valve replacement with the Björk–Shiley tilting disc valve were performed in 8 patients and in 3 of the patients re-implantations of the coronary arteries were also performed. Six patients underwent graft replacement with resuspension of the aortic commissures. Graft replacement only was performed in 2 patients. Eight operated patients are still alive after a mean follow-up period of more than 4 years. Four of six patients, who were not operated upon, died early and only one patient in the non-treated group is still alive (follow-up period 1 year). Nine of 19 patients with descending aneurysms were operated upon and 6 died early (67%). Only 3 of 10 patients (30%) died in the medically treated group. Two patients who underwent operation are alive 16 and 17 years postoperatively. Five of 10 patients in the medically treated group are alive after a mean follow-up period of 5 years. Early operation is strongly recommended for patients with dissecting aneurysms localized to the ascending aorta. For descending aneurysms medical treatment with antihypertensive drugs is the method of choice. Operation should be performed only if dissection continues and if there is significant compromise or occlusion of a vital aortic branch and also if there is an impending rupture.

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