Shinichi Iwakoshi1, Yoshihito Irie2, Yoshiaki Katada2, Shoji Sakaguchi3, Norio Hongo4, Katsuki Oji4, Tetsuya Fukuda5, Hitoshi Matsuda6, Ryota Kawasaki7, Takanori Taniguchi8, Manabu Motoki9, Makiyo Hagihara10, Yoshihiko Kurimoto11, Noriyasu Morikage12, Hiroshi Nishimaki13, Yukihisa Ogawa14, Eijun Sueyoshi15, Kyozo Inoue16, Hideyuki Shimizu17, Ichiro Ideta18, Takatoshi Higashigawa19, Osamu Ikeda20, Naokazu Miyamoto21, Motoki Nakai22, Takahiro Nakai23, Takashi Inoue24, Takeshi Inoue25, Shigeo Ichihashi23, Kimihiko Kichikawa23. 1. Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan. shinichi18548342@gmail.com. 2. Department of Cardiovascular Surgery, Iwaki City Medical Center, Iwaki, Japan. 3. Department of Radiology, Matsubara Tokusyukai Hospital, Matsubara, Japan. 4. Department of Radiology, Faculty of Medicine, Oita University, Yufu, Japan. 5. Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan. 6. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan. 7. Department of Radiology, Hyogo Brain and Heart Center, Himeji, Japan. 8. Department of Radiology, Tenri Hospital, Tenri, Japan. 9. Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Japan. 10. Department of Radiology, Aichi Medical University, Nagakute, Japan. 11. Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Japan. 12. Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan. 13. Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan. 14. Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan. 15. Department of Radiological Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. 16. Department of Cardiovascular Surgery, Kobe Rosai Hospital, Kobe, Japan. 17. Department of Cardiovascular Surgery, Keio University, Tokyo, Japan. 18. Department of Cardiovascular Medicine & Surgery, Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan. 19. Department of Radiology, Mie University Hospital, Tsu, Japan. 20. Departments of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan. 21. Department of Radiology, Kita-Harima Medical Center, Ono, Japan. 22. Department of Radiology, Wakayama Medical University, Wakayama, Japan. 23. Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan. 24. Institute for Clinical and Translational Science, Nara Medical University, Kashihara, Japan. 25. Department of Central Radiology, Nara Medical University, Kashihara, Japan.
Abstract
PURPOSE: To investigate the relationships between indications for thoracic endovascular aortic repair for acute/subacute complicated Stanford type B aortic dissection and clinical outcomes, and complications specific to thoracic endovascular aortic repair. MATERIAL AND METHODS: The J-predictive study retrospectively collected data of patients treated with thoracic endovascular aortic repair for complicated Stanford type B aortic dissection at 20 institutions from January 2012 to March 2017. From the database, those treated for acute/subacute complicated Stanford type B aortic dissection were extracted (n = 118; 96 men; average age, 66.1 years; standard deviation, ± 13) and classified into groups 1, 2, and 3 according to thoracic endovascular aortic repair indications (rupture, superior mesenteric artery malperfusion, and renal or lower extremity malperfusion, respectively). Primary and secondary measures were mortality (overall and aortic-related) and complications related to thoracic endovascular aortic repair, respectively. For each outcome, the risks of being in groups 1 and 2 were statistically compared with that of being in group 3 as a control using Fisher's exact test. RESULTS: Mortality rate (odds ratio, 5.22; 95% confidence interval [CI], 1.33-20.53) and prevalence of paraparesis/paraplegia (odds ratio, 30.46; confidence interval, 1.71-541.77) were higher in group 1 than in group 3. Compared to group 3, group 2 showed no statistically significant differences in mortality or complications related to thoracic endovascular aortic repair. CONCLUSIONS: Rupture as an indication for thoracic endovascular aortic repair for type B aortic dissection was more likely to result in worse mortality and high prevalence of spinal cord ischemia. LEVEL OF EVIDENCE: Level 4, Case series.
PURPOSE: To investigate the relationships between indications for thoracic endovascular aortic repair for acute/subacute complicated Stanford type B aortic dissection and clinical outcomes, and complications specific to thoracic endovascular aortic repair. MATERIAL AND METHODS: The J-predictive study retrospectively collected data of patients treated with thoracic endovascular aortic repair for complicated Stanford type B aortic dissection at 20 institutions from January 2012 to March 2017. From the database, those treated for acute/subacute complicated Stanford type B aortic dissection were extracted (n = 118; 96 men; average age, 66.1 years; standard deviation, ± 13) and classified into groups 1, 2, and 3 according to thoracic endovascular aortic repair indications (rupture, superior mesenteric artery malperfusion, and renal or lower extremity malperfusion, respectively). Primary and secondary measures were mortality (overall and aortic-related) and complications related to thoracic endovascular aortic repair, respectively. For each outcome, the risks of being in groups 1 and 2 were statistically compared with that of being in group 3 as a control using Fisher's exact test. RESULTS: Mortality rate (odds ratio, 5.22; 95% confidence interval [CI], 1.33-20.53) and prevalence of paraparesis/paraplegia (odds ratio, 30.46; confidence interval, 1.71-541.77) were higher in group 1 than in group 3. Compared to group 3, group 2 showed no statistically significant differences in mortality or complications related to thoracic endovascular aortic repair. CONCLUSIONS: Rupture as an indication for thoracic endovascular aortic repair for type B aortic dissection was more likely to result in worse mortality and high prevalence of spinal cord ischemia. LEVEL OF EVIDENCE: Level 4, Case series.
Authors: M D Dake; N Kato; R S Mitchell; C P Semba; M K Razavi; T Shimono; T Hirano; K Takeda; I Yada; D C Miller Journal: N Engl J Med Date: 1999-05-20 Impact factor: 91.245
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Authors: Jon S Matsumura; Richard P Cambria; Michael D Dake; Randy D Moore; Lars G Svensson; Scott Snyder Journal: J Vasc Surg Date: 2008-02 Impact factor: 4.268