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Ann Thorac Surg 2004;77:2012-2020
© 2004 The Society of Thoracic Surgeons

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Original article: cardiovascular

Acute dissection of the descending aorta: noncommunicating versus communicating forms

^a Department of Radiology (Section of Cardiovascular Imaging), The Cleveland Clinic Foundation, Cleveland, Ohio, USA
^b Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
^c Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
^d Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Accepted for publication August 19, 2003.

^* Address reprint requests to Dr White, Section of Cardiovascular Imaging, Departments of Radiology and Cardiovascular Medicine, Cleveland Clinic Foundation, Desk HB6, 9500 Euclid Ave, Cleveland, OH 44195, USA.
e-mail: whiter{at}ccisd1.ccf.org

BACKGROUND: Noncommunicating dissecting intramural hematoma is an aortic dissection variant, characterized by absent flow within the false lumen. Noncommunicating dissecting intramural hematoma is thought to be more stable than communicating dissection when beginning in the descending aorta. This study assessed clinical characteristics, anatomic characteristics, and 1-year outcomes in acute descending noncommunicating dissecting intramural hematoma versus communicating dissection.

METHODS: Retrospective database review identified patients who underwent magnetic resonance or computed tomography imaging revealing acute descending noncommunicating dissecting intramural hematoma or communicating dissection. Comparisons of clinical and anatomic characteristics and 1-year outcomes were performed.

RESULTS: Twenty-four noncommunicating dissecting intramural hematoma and 36 communicating dissection cases were identified. Patients with noncommunicating dissecting intramural hematoma were older (68.5 ± 8.8 versus 61.8 ± 11.6 years; p < 0.05). Although noncommunicating dissecting intramural hematoma often showed abdominal aorta extension (50%), the infrarenal level was spared. Communicating dissection characteristically extended beyond the diaphragm (89%), including into the infrarenal aorta (28%). There was no significant difference in rates of adverse clinical events for noncommunicating dissecting intramural hematoma versus communicating dissection (13% versus 30%; 0.10 > p > 0.05). By follow-up imaging (87% of population), aortic deterioration was more frequent in noncommunicating dissecting intramural hematoma versus communicating dissection cases (60% versus 15%; p < 0.005).

CONCLUSIONS: Acute descending noncommunicating dissecting intramural hematoma and communicating dissection represent two variants, with differing clinical and anatomic characteristics, but comparable levels of 1-year morbidity.