Management of isolated dissection of the abdominal aorta: a single-centre experience

Abstract

Objectives: Isolated abdominal aortic dissection (IAAD) is a rare disease. Currently, there is no consensus on the management of IAAD. Our goal was to report our experience with the management of IAAD.

Methods: A cohort of 45 consecutive patients with IAAD was treated between January 2010 and December 2018. We reviewed the demographics, clinical features, therapeutic modalities and follow-up results.

Results: A total of 33 patients had successful endovascular repair (EVAR) and 12 patients underwent conservative treatment initially. During a mean follow-up of 16.6 months, 2 of the patients in the EVAR group had endoleak; neither of them needed reintervention. Complete or partial thrombosis of the false lumens was seen in all patients (88% and 12%) on the latest computed tomographic angiography images, and a significant enlargement of the true lumen and regression of the false lumen and maximal abdominal aortic diameter were observed in all patients (P < 0.001). In the group receiving conservative treatment, 3 patients were lost to follow-up; 1 patient died; 2 patients had small re-entry sites, neither of which needed intervention; 1 patient had EVAR; and the others remain symptom-free. The latest computed tomographic angiography images showed that 1 patient had spontaneous healing with complete thrombosis of the false lumen, 7 patients had partial thrombosis and the diameter of the maximal abdominal aortic and false lumen remained stable or was less decreased.

Conclusions: For patients with IAAD, close surveillance is necessary. In addition, EVAR is an effective therapeutic method with a high technical success rate and low complication rate for carefully selected patients.

Keywords: Aneurysm; Aorta; Dissection; Stent; Treatment.