Document Detail


Stent grafting for aneurysmal degeneration of chronic descending thoracic aortic dissections.
MedLine Citation:
PMID:  22244358     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The objective of this study was to examine the results of thoracic endovascular aneurysm repair (TEVAR) for chronic descending thoracic aortic (DTA) dissections with aneurysmal degeneration.
METHODS: Over 70 months at a single institution, 27 patients underwent TEVAR for aneurysms related to chronic (>6 weeks) DTA dissections.
RESULTS: Mean patient age was 67.5 ± 9.6 years; 18 were men. Primary indications for repair were aneurysm size (n = 20), rapid aneurysmal growth (n = 5), saccular aneurysm (n = 1), and rupture (n = 1). Preoperative false lumen status was patent in 18 patients, partially thrombosed in 8 patients, and unknown in the patient whose aneurysm ruptured. The proximal entry tear was covered in all 27 patients. Fourteen patients required coverage of the left subclavian artery, of which 9 patients underwent prophylactic revascularization. On completion angiogram, no patient had antegrade perfusion of the aneurysmal false lumen. There were three procedural complications: 2 patients sustained paraparesis (one resolved and one improved), and 1 patient had an access injury requiring stent graft placement. Thirty-day mortality was 3.7% (1 of 27); the one death was in the patient whose aneurysm ruptured. Of the 26 surviving patients, 23 (88.5%) had thrombosis of the aneurysmal false lumen. Twenty-two patients (84.6%) had stability or decrease in maximal aneurysm diameter on last radiographic follow-up at 18 ± 20 months. Three-year Kaplan-Meier survival was 90.3% ± 6.5% in the 26 patients who survived to hospital discharge, with a mean follow-up of 27.3 ± 22.1 months. In patients with preoperatively partially thrombosed false lumens (n = 8), 3-year survival was 100%.
CONCLUSIONS: TEVAR for aneurysms due to chronic dissections of the DTA can be performed safely and effectively at midterm follow-up according to this single-institution study. Stent graft therapy may be of particular benefit in patients presenting with partially thrombosed false lumens.
Authors:
Derek P Nathan; Edward Y Woo; Ronald M Fairman; Grace J Wang; Alberto Pochettino; Nimesh D Desai; Joseph E Bavaria; Benjamin M Jackson
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2012-01-11
Journal Detail:
Title:  Journal of vascular surgery     Volume:  55     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-02     Completed Date:  2012-05-30     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:  963-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aneurysm, Dissecting / mortality*,  radiography,  surgery*
Angioplasty / methods
Aortic Aneurysm, Thoracic / mortality*,  radiography,  surgery*
Blood Vessel Prosthesis Implantation / methods*
Cause of Death*
Chronic Disease
Cohort Studies
Female
Follow-Up Studies
Hospital Mortality / trends
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Postoperative Complications / mortality,  physiopathology
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Severity of Illness Index
Stents

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


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