Acute Aortic Dissection: Experience in Yamagata Prefecture in 2000

Address for Correspondence : Yasuhisa Shimazaki, Second Department of Surgery, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan Objective: Prefectural clinico epidemiological survey of acute aortic dissection has not been widely carried out. Methods: We collected data of all patients with acute aortic dissection in Yamagata Prefecture, and retrospectively reviewed their primary treatments throughout 2000. Results: There were 71 patients with an acute aortic dissection and an incidence calculated from this number was 5.7 per 100,000 people per year. Patient's age was 2392(69+14) years. Male and female ratio was 44/27. Stanford type A aortic dissection was 35 patients and B 35. Complications of acute aortic dissection were shock in 12, cardiac tamponade in 16, rupture in 5, abdominal ischemia in 8, limb ischemia in 6 and brain infarction in 2. Two patients were in cardiac pulmonary arrest on arrival. Overall inhospital mortality was 13%, except for 2 patients. In Stanford A type aortic dissection, surgery was done in 21 and mortality was 9.5%; among those not receiving surgery mortality was 29%. In Stanford type B aortic dissection, death occurred in 2 patients out of 5 after emergency operation, and no putients out of 30 who were medically treated. Conclusion: Incidence of acute aortic dissection calculated from this survey was 5.7 per 100,000 people per year in Yamagata Prefecture. Seven of 71 (10%) died in the acute phase. Operative mortality for Stanford type A aortic dissection was 9.5%, while that of medical management was 29%. Operative mortality for Stanford type B aortic dissection was high, but medical treatment had no mortality. More aggressive treatment would improve initial results of acute aortic dissection.