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

Abstract

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.