Dominik Wiedemann1, Marek Ehrlich2, Philippe Amabile3, Luigi Lovato4, Hervé Rousseau5, Arturo Evangelista-Masip6, Patrick Moeller7, Joseph Bavaria7. 1. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: dominik.wiedemann@meduniwien.ac.at. 2. Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. 3. Department of Vascular Surgery, Hôpital de la Timone, Marseille, France. 4. Cardiovascular Department, Unit of Cardiovascular Radiology, University Hospital S. Orsola, Bologna, Italy. 5. Department of Radiology, University Hospital Rangueil, Toulouse, France. 6. Department of Cardiology, General Hospital Vall d'Hebron, Barcelona, Spain. 7. Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, Pa.
Abstract
OBJECTIVE: The objective of this study was to assess midterm results of emergency endovascular stent grafting for patients with life-threatening complications of acute type B aortic dissection. METHODS: Between March 1999 and November 2011, 110 patients (86 men, 24 women) with complications of acute type B aortic dissection (mean age, 61 years; range, 19-87 years) were treated with thoracic endovascular aortic repair for malperfusion (55.5%) or aortic rupture (53.6%) in five major European referral centers and one U.S. referral center. Additional comorbidities included hypertension in 90 patients (82%), diabetes in 14 patients (13%), and chronic obstructive pulmonary disease in six patients (6%). Eleven patients (10%) had undergone previous aortic surgery. RESULTS: Overall hospital mortality was 12% (n = 13), with 14 late deaths after hospital discharge. In-hospital complications occurred in 32 patients (36%); 10 patients developed postoperative renal failure, five patients experienced new permanent neurologic symptoms, and six patients (5.4%) experienced retrograde type A aortic dissection. Furthermore, nine patients (8%) developed an early type I endoleak. Actuarial survival at 1 and 5 years was 85% and 73%, respectively. Postprocedural computed tomography angiography showed complete or partial thrombosis of the false lumen at the stent graft level in 61% and 23% of all patients, respectively. Freedom from treatment failure according to the Stanford classification was 82%, 75%, and 59% at 1, 3, and 5 years. CONCLUSIONS: Endovascular repair of complicated acute type B aortic dissection is proven to be a technically feasible and effective treatment modality in this relatively difficult patient cohort. Short-term and midterm results are persuasive; however, the long-term efficacy needs to be further evaluated.
OBJECTIVE: The objective of this study was to assess midterm results of emergency endovascular stent grafting for patients with life-threatening complications of acute type B aortic dissection. METHODS: Between March 1999 and November 2011, 110 patients (86 men, 24 women) with complications of acute type B aortic dissection (mean age, 61 years; range, 19-87 years) were treated with thoracic endovascular aortic repair for malperfusion (55.5%) or aortic rupture (53.6%) in five major European referral centers and one U.S. referral center. Additional comorbidities included hypertension in 90 patients (82%), diabetes in 14 patients (13%), and chronic obstructive pulmonary disease in six patients (6%). Eleven patients (10%) had undergone previous aortic surgery. RESULTS: Overall hospital mortality was 12% (n = 13), with 14 late deaths after hospital discharge. In-hospital complications occurred in 32 patients (36%); 10 patients developed postoperative renal failure, five patients experienced new permanent neurologic symptoms, and six patients (5.4%) experienced retrograde type A aortic dissection. Furthermore, nine patients (8%) developed an early type I endoleak. Actuarial survival at 1 and 5 years was 85% and 73%, respectively. Postprocedural computed tomography angiography showed complete or partial thrombosis of the false lumen at the stent graft level in 61% and 23% of all patients, respectively. Freedom from treatment failure according to the Stanford classification was 82%, 75%, and 59% at 1, 3, and 5 years. CONCLUSIONS: Endovascular repair of complicated acute type B aortic dissection is proven to be a technically feasible and effective treatment modality in this relatively difficult patient cohort. Short-term and midterm results are persuasive; however, the long-term efficacy needs to be further evaluated.
Authors: Rana O Afifi; Harleen K Sandhu; Samuel S Leake; Mina L Boutrous; Varsha Kumar; Ali Azizzadeh; Kristofer M Charlton-Ouw; Naveed U Saqib; Tom C Nguyen; Charles C Miller; Hazim J Safi; Anthony L Estrera Journal: Circulation Date: 2015-08-25 Impact factor: 29.690
Authors: Jong Hyun Choi; Sang-Pil Kim; Han Cheol Lee; Tae Sik Park; Jong Ha Park; Bo Won Kim; Jinhee Ahn; Jin Sup Park; Hye Won Lee; Jun-Hyok Oh; Jung Hyun Choi; Kwang Soo Cha; Taek Jong Hong Journal: Korean J Intern Med Date: 2020-04-10 Impact factor: 2.884