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Midterm results after endovascular treatment of acute, complicated type B aortic dissection.
MedLine Citation:
PMID:  20971237     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The purpose of this study was to assess the efficacy and midterm results of endovascular treatment of acute, complicated type B aortic dissection. METHODS: Between January 2001 and February 2010, 32 patients (7 women, 25 men) with acute, complicated type B aortic dissection (mean age, 56 years; range, 35 to 83 years), defined as either aortic rupture, malperfusion, intractable pain, or uncontrolled hypertension, underwent endovascular stent graft placement with either the Gore Excluder/TAG device (n = 11), Medtronic Talent/Valiant device (n = 16), Bolton Relay (n = 2), or a combination of these stents (n = 3). Follow-up was 94% complete and averaged 26 ± 23 months. RESULTS: Technical feasibility and success with deployment proximal to the entry tear was 87%, requiring partial or total coverage of the left subclavian artery (LSA) in 9 patients (28%). Hospital mortality was 12% ± 11% (95% confidence limit) with 2 late deaths (17 and 98 months after implant). Causes of hospital death included rupture in 2, retrograde type A dissection in 1, and multiorgan failure in 1 patient. Three patients (11%) experienced new neurologic complications (2 paraparesis and 1 hemiparesis). Six patients with malperfusion required branch vessel stenting. Furthermore, 2 had an early type Ia endoleak. Actuarial survival at 1 and 5 years was 81% and 76%, respectively. Freedom from treatment failure at 1 and 5 years (including reintervention, aortic rupture, device-related complication, and aortic related death) was 78% and 61%, respectively. CONCLUSIONS: Endovascular stent-graft placement in acute, complicated type B aortic dissection proves to be a promising alternative therapeutic treatment modality in this relatively difficult patient cohort. Refinements, especially in stent design and application, may further improve the prognosis of patients in this life-threatening situation.
Marek P Ehrlich; Julia Dumfarth; Maria Schoder; Roman Gottardi; Johannes Holfeld; Andrzej Juraszek; Tomasz Dziodzio; Martin Funovics; Christian Loewe; Michael Grimm; Gottfried Sodeck; Martin Czerny
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  90     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-25     Completed Date:  2010-11-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1444-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Department of Cardiothoracic Surgery, Division of Cardiovascular and Interventional Radiology, University of Vienna, Vienna, Austria.
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MeSH Terms
Acute Disease
Aged, 80 and over
Aneurysm, Dissecting / mortality,  surgery*
Aorta, Thoracic / surgery*
Aortic Aneurysm, Thoracic / mortality,  surgery*
Blood Vessel Prosthesis Implantation / methods*
Follow-Up Studies
Hospital Mortality
Middle Aged
Comment In:
Ann Thorac Surg. 2010 Nov;90(5):1448-9   [PMID:  20971238 ]

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