Document Detail


Risk factor analysis of thoracic endovascular repair using the Matsui-Kitamura stent graft for acute aortic emergencies in the descending thoracic aorta.
MedLine Citation:
PMID:  20855177     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: In recent years, thoracic endovascular aneurysm repair (TEVAR) has been attempted for acute aortic emergencies (AAEs). However, the risk factors for achieving good results have not been identified. Besides focusing on Acute Physiology and Chronic Health Evaluation (APACHE) II score as a general indicator of patient condition, we analyzed both preoperative factors and intraoperative/postoperative factors. The purpose of this study was to identify those factors affecting the results of TEVAR using our Matsui-Kitamura stent graft (MKSG) for AAEs involving descending thoracic aortic aneurysm.
METHODS: Between July 2000 and June 2008, a total of 32 patients (23 men, 9 women) with AAEs underwent endovascular repair. AAE was a result of aortic aneurysm rupture in 16 cases, rupture of penetrating atherosclerotic ulcer in 2 cases, traumatic aortic injury in 9 cases, complicated type B dissection in 4 cases, and aortic infiltration of sarcoma in 1 case. Low blood pressure in 6 patients, acute renal failure in 7 patients, anemia due to bleeding in 12 patients were found at the time of operation. Urgent TEVAR using the MKSG was performed. Perioperative and long-term results for these patients were investigated.
RESULTS: The delivery and technical success rate for TEVAR using the MKSG, was 100%. Perioperative mortality was 12.5%, and 5-year survival rate was 71%. In both univariate and multivariate analysis, the APACHE II score clarified a risk factor. Among the various elements of an APACHE II score, age, hematocrit, and total score were identified as significant factors. The mean of an APACHE II score was 9.5. Patients with an APACHE II score ≥ 10 showed significantly lower 5-year survival rates than patients with an APACHE II score ≤ 9.
CONCLUSIONS: Good results were obtained using TEVAR to treat AAEs with MKSGs, both perioperatively and during medium-term follow-up. Evaluation of risk factors for TEVAR of AAEs showed the utility of APACHE II score (particularly age, hematocrit, and total score) with a score ≥ 10 indicating high risk.
Authors:
Hiroshi Ohtake; Keiichi Kimura; Junichirou Sanada; Osamu Matsui; Go Watanabe
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Publication Detail:
Type:  Journal Article     Date:  2010-09-19
Journal Detail:
Title:  Journal of vascular surgery     Volume:  52     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-14     Completed Date:  2011-04-06     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1464-70     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of General & Cardiothoracic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan. ohtake@med.kanazawa-u.ac.jp
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MeSH Terms
Descriptor/Qualifier:
APACHE
Adult
Aged
Aged, 80 and over
Aorta, Thoracic / injuries,  surgery*
Aortic Aneurysm, Thoracic / surgery*
Aortic Rupture / surgery
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation*
Emergencies
Endovascular Procedures* / adverse effects
Female
Humans
Male
Middle Aged
Prosthesis Design
Risk Factors
Stents*

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


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