Dittmar Böckler1, Claudio Bianchini Massoni2, Philipp Geisbüsch3, Maani Hakimi3, Hendrik von Tengg-Kobligk4, Alexander Hyhlik-Dürr3. 1. Department of Vascular and Endovascular Surgery, Ruprecht Karls-University Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. dittmar.boeckler@med.uni-heidelberg.de. 2. Unit of Vascular Surgery, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy. 3. Department of Vascular and Endovascular Surgery, Ruprecht Karls-University Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. 4. Department of Diagnostic, Interventional and Pediatric Radiology University Hospital of Bern, Bern, Switzerland.
Abstract
OBJECTIVE: This study aims to report the management of patients with spontaneous isolated dissection of the abdominal aorta (sIAAD). METHODS: A cohort of 18 consecutive patients (12 male, mean age 58 years) with sIAAD was treated between 1990 and 2009. Dissection was asymptomatic in ten and symptomatic in eight patients. Retrospective data analysis from patient charts was performed. Follow-up included clinical examination, ultrasound, and/or CT-angiography. Mean follow-up was 54 months (range 1-211). RESULTS: In total, eight out of 18 received invasive treatment. All asymptomatic patients initially underwent conservative treatment and surveillance. Spontaneous false lumen thrombosis occurred in four (40 %), and three patients showed relevant aneurysmatic progression and underwent elective invasive treatment (open n = 2, endovascular n = 1), representing a crossover rate of 30 %. Late mortality was 20 % (n = 2) in this group. In symptomatic patients, five underwent urgent treatment due to persistent abdominal or back pain (n = 4) or contained rupture (n = 1); one was treated for claudication. The remaining two patients presented with irreversible spinal cord ischemia and were treated conservatively. Three patients were treated by open surgery and three by endovascular interventions (two stentgrafts, one Palmaz XXL stent). Early and late morbidity and mortality was 0 % in this group. There were no reinterventions CONCLUSION: The majority of patients with sIADD require invasive treatment, with EVAR being the preferable treatment option today. In asymptomatic IADD, primary surveillance is justifiable, but close surveillance due to expansion is necessary.
OBJECTIVE: This study aims to report the management of patients with spontaneous isolated dissection of the abdominal aorta (sIAAD). METHODS: A cohort of 18 consecutive patients (12 male, mean age 58 years) with sIAAD was treated between 1990 and 2009. Dissection was asymptomatic in ten and symptomatic in eight patients. Retrospective data analysis from patient charts was performed. Follow-up included clinical examination, ultrasound, and/or CT-angiography. Mean follow-up was 54 months (range 1-211). RESULTS: In total, eight out of 18 received invasive treatment. All asymptomatic patients initially underwent conservative treatment and surveillance. Spontaneous false lumen thrombosis occurred in four (40 %), and three patients showed relevant aneurysmatic progression and underwent elective invasive treatment (open n = 2, endovascular n = 1), representing a crossover rate of 30 %. Late mortality was 20 % (n = 2) in this group. In symptomatic patients, five underwent urgent treatment due to persistent abdominal or back pain (n = 4) or contained rupture (n = 1); one was treated for claudication. The remaining two patients presented with irreversible spinal cord ischemia and were treated conservatively. Three patients were treated by open surgery and three by endovascular interventions (two stentgrafts, one Palmaz XXL stent). Early and late morbidity and mortality was 0 % in this group. There were no reinterventions CONCLUSION: The majority of patients with sIADD require invasive treatment, with EVAR being the preferable treatment option today. In asymptomatic IADD, primary surveillance is justifiable, but close surveillance due to expansion is necessary.
Authors: J Flores; T Kunihara; N Shiiya; K Yoshimoto; K Matsuzaki; M Nakamura; F Okamoto; K Nakanishi; J Matano; A Yamada; R Maruyama; K Sakai; K Yasuda Journal: Vasa Date: 2005-05 Impact factor: 1.961
Authors: Santi Trimarchi; Thomas Tsai; Kim A Eagle; Eric M Isselbacher; Jim Froehlich; Jeanna V Cooper; Vincenzo Rampoldi; Gilbert R Upchurch Journal: J Vasc Surg Date: 2007-11 Impact factor: 4.268