Document Detail


Midterm results for endovascular repair of complicated acute and chronic type B aortic dissection.
MedLine Citation:
PMID:  20103214     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) for the management of type B aortic dissections has become more commonplace despite some controversy. Results of endovascular management of complicated acute (<2 weeks from symptom onset) and chronic (>2 weeks) type B aortic dissection with a view towards determining safety, efficacy, and requirement for secondary procedures are reviewed. METHODS: Between June 2005 and November 2008, 55 patients (41 men) with a mean age of 59 +/- 12 years (range, 31 to 77 years) underwent TEVAR for the management of complicated acute (n = 22) or chronic (n = 33) type B dissection. Indications in acute dissection included impending or frank rupture in 11 and malperfusion syndromes in 11; the indication in chronic dissections was aneurysmal degeneration in 33. RESULTS: Primary technical success was 100%. In-hospital and 30-day rates of death, stroke, and permanent paraplegia/paresis were 2% (n = 1), 0%, and 2% (n = 1), respectively. Median follow-up was 7.1 months (range, 1 to 38 months). Overall actuarial midterm survival was 63% at 38 months, with an aorta-specific actuarial survival of 94%. Two patients (4%) required late conversion to open repair. Postoperative type I or III endoleak occurred in 3 (6%) and type II endoleak in 7 (15%). Two patients underwent subsequent endovascular occlusion. The composite reintervention rate in follow-up was 23.4% (n = 13). CONCLUSIONS: Endovascular repair for complicated acute and chronic type B dissection is safe and effective at early midterm follow-up. TEVAR for type B dissection requires more secondary interventions and imaging surveillance than conventional open reconstruction. Longer-term follow-up is needed to determine the durability of this approach.
Authors:
Cyrus J Parsa; Jacob N Schroder; Mani A Daneshmand; Richard L McCann; G Chad Hughes
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  89     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-27     Completed Date:  2010-03-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  97-102; discussion 102-4     Citation Subset:  AIM; IM    
Copyright Information:
2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Aneurysm, Dissecting / diagnosis,  mortality,  surgery*
Aortic Aneurysm, Thoracic / diagnosis,  mortality,  surgery*
Chronic Disease
Female
Follow-Up Studies
Humans
Male
Middle Aged
Retrospective Studies
Severity of Illness Index
Survival Rate / trends
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
United States / epidemiology
Vascular Surgical Procedures / methods*

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


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