Emergency endovascular stent grafting in acute complicated type B dissection.
Publication/Presentation Date
11-1-2014
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.
Volume
60
Issue
5
First Page
1204
Last Page
1208
ISSN
1097-6809
Published In/Presented At
Wiedemann, D., Ehrlich, M., Amabile, P., Lovato, L., Rousseau, H., Evangelista-Masip, A., Moeller, P., & Bavaria, J. (2014). Emergency endovascular stent grafting in acute complicated type B dissection. Journal of vascular surgery, 60(5), 1204–1208. https://doi.org/10.1016/j.jvs.2014.06.001
Disciplines
Medicine and Health Sciences
PubMedID
24998839
Department(s)
Department of Surgery
Document Type
Article