Results of a new surgical paradigm: endovascular repair for acute complicated type B aortic dissection.
Publication/Presentation Date
7-1-2008
Abstract
BACKGROUND: Conventional open repair of acute complicated type B aortic dissection is associated with significant morbidity and mortality. This study examined the results of thoracic endovascular aortic repair (TEVAR) in acute type B aortic dissection complicated with rupture or malperfusion syndrome.
METHODS: From 2004 through 2007, 35 patients (22 men) with acute complicated type B aortic dissection were treated with TEVAR. Indications included rupture in 18 (51.4%) and malperfusion syndrome in 17 (48.6%; mesenteric or renal, 5;lower extremities, 3; both, 9). Three types of endograft devices were used (mean per patient, 1.9 devices). Intravascular ultrasound imaging was used in 15 patients (42.8%). In patients with malperfusion syndrome, distal adjunct procedures to expand the true lumen included infrarenal aortic stents in 4, mesenteric/renal stents in 4, and iliofemoral stents in 7. Follow-up was 93.9% during a period of 18.3 months (range, 3 to 47 months).
RESULTS: The mean age was 58.6 +/- 13.4 years. Technical success (coverage of the primary tear site) was achieved in 34 patients (97.1%). Coverage of the left subclavian artery was required in 25 patients (71.4%). Thirty-day mortality was 2.8%. One-year survival was 93.4% +/- 4.6%. Complications included permanent renal failure (2.8%), stroke (2.8%), spinal cord ischemia (transient [5.7%], permanent [(2.8%]), and vascular access (14.2%). The mean intensive care unit and hospital stay were 4.7 +/- 2.6 and 16.7 +/- 12.0 days, respectively.
CONCLUSIONS: Endovascular repair of acute complicated type B aortic dissection is associated with low morbidity and mortality and has emerged as the surgical therapy of choice.
Volume
86
Issue
1
First Page
87
Last Page
93
ISSN
1552-6259
Published In/Presented At
Szeto, W. Y., McGarvey, M., Pochettino, A., Moser, G. W., Hoboken, A., Cornelius, K., Woo, E. Y., Carpenter, J. P., Fairman, R. M., & Bavaria, J. E. (2008). Results of a new surgical paradigm: endovascular repair for acute complicated type B aortic dissection. The Annals of thoracic surgery, 86(1), 87–94. https://doi.org/10.1016/j.athoracsur.2008.04.003
Disciplines
Medicine and Health Sciences
PubMedID
18573403
Department(s)
Department of Surgery
Document Type
Article