Evidence of a clotted false lumen in patients with acute aortic dissection has been considered to be a primary indication for medical rather than surgical therapy. A review of recent publications shows that 14 of 15 such patients survived with medical management. We present three patients who had radiographic, surgical, or necropsy evidence of acute aortic dissection with a clotted false lumen, who suffered further dissection in spite of adequate medical therapy. Our experience indicates that this condition is not as stable as it has been considered in the past. Consequently, we believe that great caution should be exercised in the application of medical therapy and in the follow-up of patients who demonstrate evidence of a clotted false lumen in an acute aortic dissection. Surgical treatment is indicated at the earliest sign of clinical or radiographic deterioration during medical therapy.
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