Document Detail


Long-term experience with descending aortic dissection: the complication-specific approach.
MedLine Citation:
PMID:  1728218     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We analyzed long-term results in 71 patients (45 men and 26 women) treated over 17 years for documented descending aortic dissection. Forty-nine patients were treated medically and 22, surgically. Actuarial survival was 65% at 1 year, 57% at 3 years, 50% at 5 years, and 28% at 10 years for the whole group. For the group treated medically, survival was 73%, 63%, 58%, and 25% at 1 year, 3 years, 5 years, and 10 years, respectively, and for the group treated surgically, 47%, 40%, and 28% at 1 year, 3 years, and 5 years, respectively. Ten (20.4%) of the 49 medically treated patients died early (5 of rupture), and 14 (28.6%) died late (8 of dissection). Five medically treated patients crossed over to surgical management for complications of dissection. Among the surgically treated patients, 6 underwent standard graft replacement of the proximal descending aorta, 8 underwent the fenestration procedure (with a standardized retroperitoneal abdominal approach), and 4 underwent the thromboexclusion operation. Specific analysis of fenestration in 14 patients (including some with persistent descending aortic dissection after replacement of the ascending aorta for dissection) found it to be safe and effective. Actuarial survival after fenestration was 77%, 77%, and 53% at 1 year, 3 years, and 5 years, respectively. Thromboexclusion was found effective, and postoperative studies confirmed thrombosis of the descending aorta with preservation of the lowest intercostal arteries. Fifteen of the 21 surviving medically treated patients agreed to return for follow-up imaging. Nine had thrombosis of the false lumen. An interesting radiographic finding was that 4 of the 15 restudied patients had a saccular aneurysm in the aorta at the level of the left subclavian artery. We recommend a complication-specific approach to the management of descending aortic dissection. Uncomplicated dissection is treated medically, whereas complicated dissection is treated surgically, with realized rupture treated by standard graft replacement, limb ischemia treated by fenestration, and enlargement or impending rupture treated by thromboexclusion.
Authors:
J A Elefteriades; J Hartleroad; R J Gusberg; A M Salazar; H R Black; G S Kopf; J C Baldwin; G L Hammond
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  53     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1992 Jan 
Date Detail:
Created Date:  1992-01-28     Completed Date:  1992-01-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  11-20; discussion 20-1     Citation Subset:  AIM; IM    
Affiliation:
Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT 06510.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aneurysm, Dissecting / diagnosis,  mortality,  surgery*
Aorta, Thoracic / radiography,  surgery
Aortic Aneurysm / diagnosis,  mortality,  surgery*
Aortic Rupture / mortality
Cause of Death
Female
Follow-Up Studies
Humans
Ischemia / etiology,  surgery
Kidney / blood supply
Leg / blood supply
Magnetic Resonance Imaging
Male
Middle Aged
Postoperative Complications / diagnosis,  mortality,  surgery*
Spinal Cord / blood supply
Survival Rate

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


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