You see a 60-year-old musician in the outpatient clinic who discharged himself 2 weeks previously following admission with a confirmed type B dissection of the aorta. He tells you that he doesn’t want to take any medication as he prefers natural healing methods. His blood pressure is 180/90 mmHg. He asks you what the future holds for him off medication.
What can you tell him that the data suggest if he has no treatment?
A. Approximately 1/6 (16%) are dead within a year and 1/5 (20%) die within 5 yearsWhilst type B dissections are not as lethal as type A dissections, they are associated with significant mortality if not treated appropriately. Mortality with no treatment is 11% at 1 month, 16% at 1 year, and 20% at 5 years. Approximately a third of survivors of acute dissection experience further dissection or rupture or will require surgery for aneurysm within 5 years. High-risk groups include the elderly, those with poorly controlled hypertension, the presence of a false lumen, larger aortic size, and Marfan syndrome. At presentation, aggressive control of blood pressure to a target of 110 mmHg with IV beta-blockers and sodium nitroprusside infusions is recommended initially, and combinations of beta-blockers, ACE inhibitors, and other antihypertensive medications as outpatients with a less aggressive target of 135/80 mmHg. Maintaining a heart rate of <60 bpm has been shown to be beneficial in preventing complications in type B dissection. Follow-up imaging, usually with CT or MRI, is recommended at 1, 3, 6, 9, and 12 months