Jip L Tolenaar1, Stuart J Hutchison2, Dan Montgomery3, Patrick O'Gara4, Rosella Fattori5, Reed E Pyeritz6, Linda Pape7, Toru Suzuki8, Arturo Evangelista9, Frans L Moll10, Vincenzo Rampoldi1, Eric M Isselbacher11, Cristoph A Nienaber12, Kim A Eagle3, Santi Trimarchi1. 1. Department of Cardiovascular Surgery, Policlinico San Donato IRCCS, Milan, Italy; 2. St. Michael's Hospital, Toronto, Ontario, Canada; 3. University of Michigan Health System, Ann Arbor, Michigan; 4. Brigham and Women's Hospital, Boston, Massachusetts; 5. S. Orsola-Malpighi Hospital, Bologna, Italy; 6. Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; 7. University of Massachusetts Hospital, Worcester, Massachusetts; 8. Department of Cardiology, University of Tokyo, Tokyo, Japan; 9. Hospital General Universitari Vall d'Hebron, Barcelona, Spain; 10. University Medical Center Utrecht, Utrecht, The Netherlands; 11. Massachusetts General Hospital, Boston, Massachusetts; 12. Thoracic Aortic Center, University of Rostock, Rostock, Germany.
Abstract
INTRODUCTION: The classical presentation of a patient with Type B acute aortic dissection (TBAAD) is characterized by severe chest, back, or abdominal pain, ripping or tearing in nature. However, some patients present with painless acute aortic dissection, which can lead to a delay in diagnosis and treatment. We utilized the International Registry on Acute Aortic Dissections (IRAD) database to study these patients. METHODS: We analyzed 43 painless TBAAD patients enrolled in the database between January 1996 and July 2012. The differences in presentation, diagnostics, management, and outcome were compared with patients presenting with painful TBAAD. RESULTS: Among the 1162 TBAAD patients enrolled in IRAD, 43 patients presented with painless TBAAD (3.7%). The mean age of patients with painless TBAAD was significantly higher than normal TBAAD patients (69.2 versus 63.3 years, P = 0.020). The presence of atherosclerosis (46.4% versus 30.1%, P = 0.022), diabetes (17.9% versus 7.5%; P = 0.018), and other aortic diseases (8.6% versus 2.3%, P= 0.051), such as prior aortic aneurysm (31% versus 18.8% P = 0.049) was more common in these patients. Median delay time between presentation and diagnosis was longer in painless patients (median 34.0 versus 19.0 hours; P = 0.006). Dissection of iatrogenic origin (19.5% versus 1.3%; P < 0.001) was significantly more frequent in the painless group. The in-hospital mortality was 18.6% in the painless group, compared with an in-hospital mortality of 9.9% in the control group (P = 0.063). CONCLUSION: Painless TBAAD is a relatively rare presentation (3.7%) of aortic dissection, and is often associated with a history of atherosclerosis, diabetes, prior aortic disease including aortic aneurysm, and an iatrogenic origin. We observed a trend for increased in-hospital mortality in painless TBAAD patients, which may be the result of a delay in diagnosis and management. Therefore, physicians should be aware of this relative rare presentation of TBAAD.
INTRODUCTION: The classical presentation of a patient with Type B acute aortic dissection (TBAAD) is characterized by severe chest, back, or abdominal pain, ripping or tearing in nature. However, some patients present with painless acute aortic dissection, which can lead to a delay in diagnosis and treatment. We utilized the International Registry on Acute Aortic Dissections (IRAD) database to study these patients. METHODS: We analyzed 43 painless TBAADpatients enrolled in the database between January 1996 and July 2012. The differences in presentation, diagnostics, management, and outcome were compared with patients presenting with painful TBAAD. RESULTS: Among the 1162 TBAADpatients enrolled in IRAD, 43 patients presented with painless TBAAD (3.7%). The mean age of patients with painless TBAAD was significantly higher than normal TBAADpatients (69.2 versus 63.3 years, P = 0.020). The presence of atherosclerosis (46.4% versus 30.1%, P = 0.022), diabetes (17.9% versus 7.5%; P = 0.018), and other aortic diseases (8.6% versus 2.3%, P= 0.051), such as prior aortic aneurysm (31% versus 18.8% P = 0.049) was more common in these patients. Median delay time between presentation and diagnosis was longer in painless patients (median 34.0 versus 19.0 hours; P = 0.006). Dissection of iatrogenic origin (19.5% versus 1.3%; P < 0.001) was significantly more frequent in the painless group. The in-hospital mortality was 18.6% in the painless group, compared with an in-hospital mortality of 9.9% in the control group (P = 0.063). CONCLUSION: Painless TBAAD is a relatively rare presentation (3.7%) of aortic dissection, and is often associated with a history of atherosclerosis, diabetes, prior aortic disease including aortic aneurysm, and an iatrogenic origin. We observed a trend for increased in-hospital mortality in painless TBAADpatients, which may be the result of a delay in diagnosis and management. Therefore, physicians should be aware of this relative rare presentation of TBAAD.
Authors: P G Hagan; C A Nienaber; E M Isselbacher; D Bruckman; D J Karavite; P L Russman; A Evangelista; R Fattori; T Suzuki; J K Oh; A G Moore; J F Malouf; L A Pape; C Gaca; U Sechtem; S Lenferink; H J Deutsch; H Diedrichs; J Marcos y Robles; A Llovet; D Gilon; S K Das; W F Armstrong; G M Deeb; K A Eagle Journal: JAMA Date: 2000-02-16 Impact factor: 56.272
Authors: Brahmajee K Nallamothu; Rajendra H Mehta; Sanjay Saint; Alfredo Llovet; Eduardo Bossone; Jeanna V Cooper; Udo Sechtem; Eric M Isselbacher; Christoph A Nienaber; Kim A Eagle; Arturo Evangelista Journal: Am J Med Date: 2002-10-15 Impact factor: 4.965
Authors: S Trimarchi; J L Tolenaar; T T Tsai; J Froehlich; M Pegorer; G R Upchurch; R Fattori; T M Sundt; E M Isselbacher; C A Nienaber; V Rampoldi; K A Eagle Journal: J Cardiovasc Surg (Torino) Date: 2012-04 Impact factor: 1.888
Authors: Santi Trimarchi; Thomas Tsai; Kim A Eagle; Eric M Isselbacher; Jim Froehlich; Jeanna V Cooper; Vincenzo Rampoldi; Gilbert R Upchurch Journal: J Vasc Surg Date: 2007-11 Impact factor: 4.268
Authors: Seung Woo Park; Stuart Hutchison; Rajendra H Mehta; Eric M Isselbacher; Jeanna V Cooper; Jianming Fang; Arturo Evangelista; Alfredo Llovet; Christoph A Nienaber; Toru Suzuki; Linda A Pape; Kim A Eagle; Jae K Oh Journal: Mayo Clin Proc Date: 2004-10 Impact factor: 7.616