| Endovascular management of chronic aortic dissection in patients with Marfan syndrome. | |
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MedLine Citation:
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PMID: 19632806 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: Marfan syndrome patients are prone to aortic dilatation, dissection, and rupture. Success of aortic root replacement has generated a cohort of patients surviving longer and presenting with distal aortic dissection and enlargement. Thoracic endovascular stent-graft repair (TEVR) is being increasingly utilized to exclude aneurysms resulting from chronic aortic dissection. This report explores the role of TEVR in Marfan patients with this pathology. METHODS: Review of a prospectively maintained database identified seven patients with Marfan syndrome offered endovascular repair of aneurysmal chronic aortic dissection. All patients had previous aortic root repair. Talent or Valiant (Medtronic Vascular, Santa Rosa, Calif) aortic stent-grafts were used to occlude the dissection entry tear and cover the thoracic aorta. Electronic data, case notes, and radiological surveillance were analyzed. RESULTS: Seven consecutive patients (six male; mean age, 45.9 +/- 10 years, range, 29 to 63) underwent successful thoracic stent-graft deployment. Mean aortic aneurysmal diameter was 63.4mm (+/-11.2) with six of seven dissections extending to the aortic bifurcation. No perioperative neurological events occurred. Thirty-day mortality was 1/7 (14%) due to congestive cardiac failure. At median 16 month follow-up, two of six cases (33%) required intervention for endoleak. Aortic false lumen thrombosis (FLT) occurred in 5/6 (83%) cases and partial FLT occurred in 1/6 (17%). All thoracic aortas continued to dilate during follow-up. Crude median aortic growth rate was 7.2 mm/year (range, 3.5 to 19 mm). CONCLUSION: TEVR in Marfan syndrome patients with chronic aortic dissection is technically feasible. However, post intervention surveillance confirms that the aorta continues to dilate despite graft deployment and false lumen thrombosis. Endovascular repair may offer a viable option in patients who have contraindications to open surgery, but longer follow up of more patients is required to define the place of this therapy. |
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Authors:
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Ian M Nordon; Robert J Hinchliffe; Peter J Holt; Rob Morgan; Marjan Jahangiri; Ian M Loftus; Matt M Thompson |
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Publication Detail:
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Type: Journal Article Date: 2009-07-26 |
Journal Detail:
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Title: Journal of vascular surgery Volume: 50 ISSN: 1097-6809 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2009 Nov |
Date Detail:
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Created Date: 2009-11-02 Completed Date: 2009-11-12 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 987-91 Citation Subset: IM |
Affiliation:
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St. George's Vascular Institute, St. James' Wing, St. George's Hospital, London, UK. inordon@sgul.ac.uk |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aneurysm, Dissecting / etiology, mortality, radiography, surgery* Aortic Aneurysm / etiology, mortality, radiography, surgery* Aortography Blood Vessel Prosthesis* Blood Vessel Prosthesis Implantation / adverse effects, instrumentation*, mortality Chronic Disease Disease Progression Female Humans Male Marfan Syndrome / complications*, mortality, radiography, surgery Middle Aged Prosthesis Failure Reoperation Retrospective Studies Stents* Time Factors Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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