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Acute Aortic Dissection Presenting with Primarily Abdominal Pain: A Rare Manifestation of a Deadly Disease

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Annals of Vascular Surgery

Abstract

The objective of this study was to determine the morbidity and mortality of patients with acute thoracic aortic dissections who present primarily with abdominal pain. Nine hundred ninety-two patients (mean age, 62.1 years ± 14.1; 68% male) encountered from 1996 to 2001 with acute thoracic aortic dissections from the International Registry of acute Aortic Dissection were studied. Patient demographics, presenting symptoms, signs of aortic dissection, aortic pathology, and mortality were compared in patients presenting primarily with abdominal pain (group I, 46 patients, 4.6%) versus all others (group II). Demographics were similar between the two groups. When signs of aortic dissection were examined, 63% of patients in group I presented with hypertension compared to only 47% of patients in group II (p = 0.04). Patients in group I were less likely to present with evidence of end-organ malperfusion. Importantly, mortality in patients with a type B dissection, specifically following surgery for the dissection, was significantly increased in patients who presented primarily with abdominal pain (group I, 28% mortality vs. group II, 10.2% mortality; p = 0.02). This study documented increased mortality in patients with acute thoracic aortic dissections who present primarily with abdominal pain, underscoring the importance of maintaining a high index of suspicion for an aortic dissection in patients who have appropriate risk factors.

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Acknowledgments

We thank Jeanna V. Cooper, MS, Jianming Fang, MD, and Dean E. Smith, PhD, University of Michigan Ann Arbor, MI, for data management and biostatistical support. The International Registry of Acute Aortic Dissection (IRAD) is supported by grants from the University of Michigan Health System and the Varbedian Fund for Aortic Research.

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Authors and Affiliations

  1. University of Michigan Health System, Ann Arbor, MI, USA

    Gilbert R. Upchurch Jr. MD, Jeanna V. Cooper MS & Kim A. Eagle MD

  2. University of Rostock, Rostock, Germany

    Christoph Nienaber MD

  3. University Hospital S. Orsola, Bologna, Italy

    Rossella Fattori MD

  4. Hospital General Universitari Vall d’Hebron, Barcelona, Spain

    Arturo Evangelista MD

  5. Mayo Clinic, Rochester, MN, USA

    Jae Oh MD

  6. Massachusetts General Hospital, Boston, MA, USA

    Eric Isselbacher MD

  7. University of Tokyo, Tokyo, Japan

    Toru Suzuki MD

Authors
  1. Gilbert R. Upchurch Jr. MD
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  2. Christoph Nienaber MD
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  3. Rossella Fattori MD
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  4. Arturo Evangelista MD
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  5. Jae Oh MD
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  6. Jeanna V. Cooper MS
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  7. Eric Isselbacher MD
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  8. Toru Suzuki MD
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  9. Kim A. Eagle MD
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Corresponding author

Correspondence to Gilbert R. Upchurch Jr. MD.

Appendix I

Appendix I

The International Registry of Acute Aortic Dissection (IRAD) Investigators

Co-Principal Investigators:

Kim A. Eagle, MD, University of Michigan, Ann Arbor, Michigan USA; Eric M. Isselbacher, MD, Massachusetts General Hospital, Boston, Massachusetts, USA; Christoph A. Nienaber, MD, University of Rostock, Rostock, Germany.

Co-Investigators:

Eduardo Bossone, MD, National Research Council, Lecce, Italy; Arturo Evangelista, MD, Hospital General Universitari Vall d’Hebron, Barcelona, Spain; Rosell Fattori, MD, University Hospital S. Orsola, Bologna, Italy; Dan Gilon, MD, Hadassah University Hospital, Jerusalem, Israel; Stuart Hutchison, MD, St. Michael’s Hospital, Toronto, Ontario, Canada; James L. Januzzi, MD, Massachusetts General Hospital, Boston, Massachusetts, USA; Alfredo Llovet, MD, Hospital Universitario “12 de Octubre”, Madrid, Spain; Rajendra H. Mehta, MD, MS, University of Michigan, Ann Arbor, Michigan, USA; Truls Myrmel, MD, Tromsø University Hospital, Tromsø, Norway; Patrick O’Gara, MD, and Joshua Beckman, MD, Brigham and Women’s Hospital, Boston, Massachusetts, USA; Jae K. Oh, MD, Mayo Clinic, Rochester, Minnesota, USA; Linda A. Pape, MD, University of Massachusetts Hospital, Worcester, Massachusetts, USA; Udo Sechtem, MD, Robert-Bosch Krankenhaus, Stuttgart, Germany, Toru Suzuki, MD, University of Tokyo, Tokyo, Japan; Santi Trimarchi, MD, Istituto Policlinico San Donato, San Donato, Italy.

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Upchurch, G.R., Nienaber, C., Fattori, R. et al. Acute Aortic Dissection Presenting with Primarily Abdominal Pain: A Rare Manifestation of a Deadly Disease. Ann Vasc Surg 19, 367–373 (2005). https://doi.org/10.1007/s10016-004-0171-x

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  • DOI: https://doi.org/10.1007/s10016-004-0171-x

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