Spontaneous dissection of the abdominal aorta: experience with five patients.

Spontaneous dissection of the infradiaphragmatic abdominal aorta is a rare form of aortic dissection. Its natural history and management are not well defined. We have recently treated five patients with spontaneous aortic dissection. Two patients had acute dissections and three had chronic dissections. Three patients developed saccular aneurysms and underwent resection. Two patients had stable dissections and were treated medically. All patients are alive and well at 6 months to 5 years. We think that spontaneous aortic dissection can be treated as a variant of type III dissection with initial medical management, reserving surgery for those patients in whom a saccular aneurysm or a complication of the dissection develops.