Document Detail

Endovascular treatment of acute complicated type B dissection: morphological changes at midterm follow-up.
MedLine Citation:
PMID:  19702338     Owner:  NLM     Status:  MEDLINE    
PURPOSE:To review midterm results and morphological changes following endovascular treatment of acute complicated type B dissection and to study the relation between extent of dissection and treatment outcome. METHODS:Between February 2001 and March 2008, 52 patients (38 men; median age 67 years, range 40-82) received thoracic stent-grafts for acute complicated type B dissections. Outcome for those patients treated for intramural hematoma (IMH; group 1, n = 7) or type IIIa dissection (group 2, n = 17) were compared to those with type IIIb dissection (group 3, n = 28). True lumen index (TLi), false lumen index (FLi; ratio of true or false lumen diameter, respectively, to the sum of both), and FL perfusion were calculated prior to treatment and at the last follow-up from computed tomographic angiography (CTA) scans. RESULTS:Perioperative morbidity and mortality rates were 28.5% and 28.5% in group 1, 18% and 12%, respectively, for group 2, and 18% and 11% for group 3. No adjunctive treatment or re-intervention was required in groups 1 or 2, while the rates were 37% and 22%, respectively, for these events in group 3 (p = 0.009 and p = 0.034, respectively, versus groups 1 + 2). Mean imaging surveillance was 31 months, and no patients were lost to follow-up. In group 2, there was 1 case of persistent FL perfusion at last CTA, whereas in group 3, 68% had persistent FL perfusion detected; the mean FLi ranged from 0.12 at the level of the carina to 0.33 at the level of the inferior mesenteric artery. Half of the patients in this group had an increase in FL diameter correlating significantly with FL perfusion, mostly distal to the stented aorta. CONCLUSION:Despite similar morbidity and perioperative mortality rates, outcomes following endovascular treatment of acute complicated type B dissection varied with the extent of the dissection. Persistent FL perfusion below the stent-graft, associated with aneurysm expansion and the need for re-intervention, was seen most often in type IIIb dissection. Patients with the more limited type IIIa dissection or IMH were likely to be cured by endovascular therapy.
Brian J Manning; Nuno Dias; Mario Manno; Thomas Ohrlander; Martin Malina; Bjorn Sonesson; Timothy Resch; Krassi Ivancev
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     Volume:  16     ISSN:  1545-1550     ISO Abbreviation:  J. Endovasc. Ther.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-08-25     Completed Date:  2009-11-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  466-74     Citation Subset:  IM    
Vascular Centre Malmö-Lund, Malmö University Hospital UMAS, Malmö, Sweden.
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MeSH Terms
Acute Disease
Aged, 80 and over
Aneurysm, Dissecting / complications,  mortality,  physiopathology,  radiography,  surgery*
Aortic Aneurysm / complications,  mortality,  physiopathology,  radiography,  surgery*
Aortography / methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects,  instrumentation,  mortality
Dilatation, Pathologic
Hematoma / etiology,  surgery
Middle Aged
Retrospective Studies
Time Factors
Tomography, X-Ray Computed
Treatment Outcome

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