[HSF] Sympathy anyone.......

[Jbflegejr at aol.com]

Having already survived for four days since the onset of the dissection, I  
would think that the risk of waiting a few more days up to a week would be  
smaller than proceeding to operation while he is coagulopathic. In Wheat's  
report of treating Type A dissections without operation, 40% survived to leave  the 
hospital. In a recent report derived from the International Registry there  
were about 160 patients who were not operated for one reason or another, mostly 
 severe comorbidities or refusal, and 40% left the hospital alive. Both of  
these groups included patients from the outset of the dissection. Since the 
risk  of dying from the dissection decreases with time, the risk your patient 
faces  after surviving the high risk days is probably less than if you proceeded 
with  operation now. John Flege



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