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Predictors of Outcome after Endovascular Repair for Chronic Type B Dissection.
MedLine Citation:
PMID:  22326695     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: To assess the durability of endovascular repair (TEVAR) in chronic type B dissection (CD) and identify factors predictive of outcome. DESIGN: Retrospective analysis of a prospective database. MATERIALS: Patients undergoing TEVAR for CD at a tertiary referral centre 2000-2010. METHODS: Analysis of pre-operative characteristics, operative outcome, false lumen thrombosis, aortic diameter and survival. RESULTS: 58 consecutive patients were included (49 elective, 9 urgent, mean age 66 years). Mean aortic diameter was 6.4 cm (Standard deviation SD 1.3 cm). Three patients died perioperatively (5%, 1 urgent, 2 elective). Complications included retrograde type A dissection (n = 3), paraplegia (1), and transient ischaemic attack (1). Estimated survival (Kaplan-Meier) was 89% (1-year) and 64% (3-years). Forty-seven patients had mid-term imaging follow-up at mean 38 months. Reintervention rate was 15% at 1-year and 29% at 3-years. Aortic diameter decreased in 24, was stable in 15 and increased in 8. Mid-term survival was higher in patients with aortic remodelling (reduction of aortic diameter >0.5 cm; 3-year 89%) than without (54%; Log Rank p = 0.005). Remodelling occurred with extensive false lumen thrombosis. CONCLUSION: Satisfactory mid-term outcome after TEVAR for CD remains a challenge. Survival is associated with aortic remodelling, which is related to persistence of flow in the false lumen.
Authors:
K Mani; R E Clough; O T A Lyons; R E Bell; T W Carrell; H A Zayed; M Waltham; P R Taylor
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-9
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  -     ISSN:  1532-2165     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Affiliation:
Department of Vascular Surgery, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK; Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
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