Clinical Analysis Of 55 Elderly Patients With Type B Aortic Dissection

Background and Objective : As a type of cardiovascular diseases with extremely high mortality,Standfordtype B aortic dissection commonly occur in middle-aged and elderly people.With the accelerating of the aging of population in China,the elderly patients with aortic dissection are becoming more and more common in clinic.Because the elderly patient with various complications have complex and atypical clinical manifestations,misdiagnosis is easily happen in clinic.What's more,therapeutic methods and prognosis management for the elderly patients usually differ from the young patients.The clinical characteristics,therapeutic effects and prognosis of elderly patients with type B aortic dissection are analyzed by single-center data analysis.Materials and methods:The data of 55 elderly(?60 years old)patients with type B aortic dissection from July 2012 to July 2016 were analyzed,with 41 male cases(74.5%)and 14 female cases(25.5%),and the mean age was(68.11±6.13)years old,among whom 19 patients were only treated with drug treatment,and 36 with endovascular surgery aided by drug treatment.All the patients were divided into drug treatment group and surgery treatment group according to treatment methods.The patients in drug treatment group were treated with therapeutic measures such as analgesia,sedation,control of heart rate,and reduction of blood pressure,and the surgery treatment group was additional treated with aorta angiography and endovascular graft exclusion.The data such as age,gender,season of onset,time of diagnosis,clinical manifestations,grading of hypertension,imaging findings on admission were analyzed.Therapeutic effect and prognosis in follow up were analyzed in both groups.And all the data of two groups were analyzed by SPSS 21.0 statistical software,and were conducted t test or chi-square test or rank test according to type of data.Results:Clinical data analysis showed that patients were more likely to suffer type B aortic dissection in spring and winter,accounting for 41 cases(74.5%).The mean age of drug treatment group was(70.68±6.84)years old,which was significantly higher than(66.75±5.33)years old of surgery treatment group(P<0.05).There were no significant differences between two groups in gender(P=0.384),time of diagnosis(P=0.093),clinical manifestations,grading of hypertension(P=0.857),administration of anti-hypertensive drugs(P=0.658),dissection involving aorta above phrenic muscle(P > 0.999),dissection involving aorta under phrenic muscle(P=0.343),and formation of intramural hematoma(P=0.067).The remission rate of symptoms in drug treatment group was significantly lower than endovascular treatment group(P<0.05).During hospitalization,there were no significant differences in the incidence rates of complications such as cerebral infarction(P>0.999),cardiac insufficiency(P=0.0.357),pleural effusion(P>0.999)and lower limb ischemia(P>0.999).Totally 53 patients were followed up with an average period of 11.2 months(range from 2 weeks to 48 months)and 2 patients were lost,and the follow-up rate was 96.4%.The follow up patients were 17 cases(89.5%)and 36 cases(100%),respectively,in drug treatment group and endovascular treatment group.The mortality rate at 30,90 and 180 d after discharge showed no significant differences between two groups(P > 0.999,P=0.220,P=1.000).The intervention rate of reoperation in drug treatment group was slightly higher than endovascular treatment group(P=0.446).Conclusion:The elderly people are more likely to suffer type B aortic disease in the relatively concentrated seasons,and the elderly patients with relatively hidden clinical symptoms should pay more attention.Endovascular surgery is still the main method for the treatment of elderly patients type B aortic dissection.