Midterm results for endovascular repair of complicated acute and chronic type B aortic dissection.
Journal Article
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.
Full Text
Duke Authors
Cited Authors
- Parsa, CJ; Schroder, JN; Daneshmand, MA; McCann, RL; Hughes, GC
Published Date
- January 2010
Published In
Volume / Issue
- 89 / 1
Start / End Page
- 97 - 102
PubMed ID
- 20103214
Pubmed Central ID
- 20103214
Electronic International Standard Serial Number (EISSN)
- 1552-6259
Digital Object Identifier (DOI)
- 10.1016/j.athoracsur.2009.09.029
Language
- eng
Conference Location
- Netherlands