Document Detail

Aortic morphology following endovascular repair of acute and chronic type B aortic dissection: implications for management.
MedLine Citation:
PMID:  18692416     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The study aimed to define early clinical outcomes, and medium term morphological changes, following endovascular treatment of acute (AAD) and chronic (CAD) Type B aortic dissections. MAIN OUTCOMES: The cohort comprised 78 patients who underwent endovascular repair for AAD (38) and CAD (40). Early and late clinical outcomes were prospectively recorded. All patients underwent serial follow up with CT scanning. False lumen thrombosis rates, true, false and total aortic short axis diameter were recorded at the mid point of the endograft and below this level in the thoracic aorta. The total maximum aortic diameter in the thoracic, abdominal aorta was quantified. RESULTS: The 30-d mortality was 2.6% in AAD and 7.5% in CAD. The 30-d stroke and paraplegia rates were 5.3% and 0% in AAD. There were no cases of stroke or paraplegia in patients with CAD. At 30 months follow up, the cumulative survival for the two groups was 93% for AAD and 66.5% for CAD (P=0.015, Kaplan Meier) and the cumulative re-intervention rate was 62% and 55% in AAD and CAD respectively (P=0.961, Kaplan-Meier). False lumen thrombosis rates were equivalent in the two groups and were higher at the level of the endograft than below this level (P<0.05). Aortic remodelling was greater in AAD, whereas the aortic dimensions after treatment of CAD remained relatively static. Up to 20% of patients in both groups demonstrated enlargement of the thoracic aorta. CONCLUSIONS: The data support the use of endovascular repair of the thoracic aorta in Type B aortic dissection. 30-d outcomes are acceptable. Patients with AAD demonstrate significant aortic remodelling whereas patients with CAD do not. This has significant implications for practice as patients with CAD must rely on maintenance of false lumen thrombosis to preserve the integrity of the endovascular repair.
D Sayer; M Bratby; M Brooks; I Loftus; R Morgan; M Thompson
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Publication Detail:
Type:  Journal Article     Date:  2008-08-08
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  36     ISSN:  1532-2165     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-22     Completed Date:  2008-11-06     Revised Date:  2009-03-31    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  522-9     Citation Subset:  IM    
St George's Vascular Institute, London, UK.
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MeSH Terms
Acute Disease
Aneurysm, Dissecting / mortality,  radiography,  surgery*
Aorta, Thoracic / pathology,  surgery*
Aortic Aneurysm, Thoracic / mortality,  radiography,  surgery*
Aortography / methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects,  instrumentation
Chronic Disease
Kaplan-Meiers Estimate
Middle Aged
Paraplegia / etiology
Patient Selection
Prospective Studies
Risk Assessment
Stroke / etiology
Thrombosis / etiology
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Comment In:
Eur J Vasc Endovasc Surg. 2008 Nov;36(5):520-1   [PMID:  18818111 ]
Eur J Vasc Endovasc Surg. 2009 Apr;37(4):498-9   [PMID:  19217808 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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