Aortic Morphology Following Endovascular Repair of Acute and Chronic Type B Aortic Dissection: Implications for Management

Sayer, D.; Bratby, Mark; Brooks, Melissa; Loftus, Ian; Morgan, Robert; Thompson, Matt

doi:10.1016/j.ejvs.2008.06.023

Cited by 175 publications

(128 citation statements)

References 18 publications

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“…19,28 However, open surgery offers a robust solution to preventing aortic-related death over long-term follow-up, 29 whereas the outcome after endovascular therapy is not as well defined, with uncertainty over the morphology of the distal aorta after TEVAR. 30 The present study has revealed that patients with both acute and chronic aortic dissection have low rates of aortic-related mortality in the midterm after TEVAR. After the initial perioperative phase, aortic-related mortality is low, which suggests that endovascular therapy has the potential to confer prevention of aortic dissection and rupture over a reasonable time period.…”

Section: Discussionmentioning

confidence: 89%

Aortic Pathology Determines Midterm Outcome After Endovascular Repair of the Thoracic Aorta

et al. 2013

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Given the spectrum of different pathologies that affect the descending thoracic aorta, it is important to define whether the outcome of TEVAR is pathology specific to refine procedural technique and endograft design. Careful analysis of long-term Background-Endovascular repair of the thoracic aorta has become an increasingly utilized therapy. Although the shortterm mortality advantage over open surgery is well documented, late mortality and the impact of presenting pathology on long-term outcomes remain poorly reported. Methods and Results-A database was built from 5 prospective studies and a single institutional series. Rates of perioperative adverse events were calculated, as were midterm death and reintervention rates. Multivariate analysis was performed with the use of logistic regression modeling. Kaplan-Meier survival curves were drawn for midterm outcomes. The database contained 1010 patients: 670 patients with thoracic aortic aneurysm, 195 with chronic type B aortic dissection, and 114 with acute type B aortic dissection. Lower elective mortality was observed in patients with chronic dissections (3%) compared with patients with aneurysms (5%). Multivariate analysis identified age, mode of admission, American Society of Anesthesiologists grade, and pathology as independent predictors of 30-day death (P < 0.05). In the midterm, the all-cause mortality rate was 8, 4.9, and 3.2 deaths per 100 patient-years for thoracic aortic aneurysm, acute type B aortic dissection, and chronic type B aortic dissection, respectively. The rates of aortic-related death were 0.6, 1.2, and 0.4 deaths per 100 patient-years for thoracic aortic aneurysm, acute type B aortic dissection, and chronic type B aortic dissection, respectively. Conclusions-This study indicated that the midterm outcomes of endovascular repair of the thoracic aorta are defined by presenting pathology, associated comorbidities, and mode of admission. Nonaortic mortality is high in the midterm for patients with thoracic aortic aneurysm, and managing modifiable risk factors appears vital. Endovascular repair of the thoracic aorta results in excellent midterm protection from aortic-related mortality, regardless of presenting pathology. (Circulation. 2013;127:24-32.)

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Section: Discussionmentioning

confidence: 89%

Aortic Pathology Determines Midterm Outcome After Endovascular Repair of the Thoracic Aorta

et al. 2013

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“…Following coverage of the primary entry tear in ATBAD, there is rapid aortic remodelling with an increase in diameter of the TL and a reduction in FL diameter. 91,192 By contrast, in chronic dissections, there is less aortic remodelling and the integrity of the endovascular repair is determined by the ability of the endovascular procedure to induce FL thrombosis. In treating chronic dissections, it has been shown that FL thrombosis occurs more often in patients with limited dissection and that FL thrombosis occurs more effectively in the stented part of the DTA.…”

Section: Recommenda On 37mentioning

confidence: 99%

“…Irrespective of the extent of aortic coverage, the dissected portion of the aorta below the diaphragm remains untreated, and there is evidence to suggest that this region may dilate over time. 91 The role of bare stents in the treatment of chronic dissection, and the effect that these stents have on aortic remodeling, remain undefined at the present time. 99 The available literature regarding TEVAR for chronic dissection in patients with MFS is sparse.…”

Section: Recommenda On 37mentioning

confidence: 99%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

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952

259

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“…Our patient had a rare true aneurysm similar to a dissecting aneurysm [7] . Usually, dissecting aneurysm is caused by an intimal tear or interstitial hemorrhage and requires emergency surgery, and has a low survival rate.…”

Section: Discussionmentioning

confidence: 99%

Surgery for rare aneurysm associated with colorectal cance

Lü¹,

Tao²,

Shen³

et al. 2009

WJG

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The occurrence of concomitant aortic aneurysm and colorectal cancer is a rare medical entity, and controversy surrounds its optimal treatment. We report a case of rectal cancer and concomitant aneurysm from the ascending aorta to the common iliac artery. As with DeBakey type Ⅰ aortic dissecting aneurysm, our patient was treated by rectal cancer resection, with preservation of the anus (Dixon operation) under controlled hypotension. Blood pressure was maintained at 80-90/ 50-60 mmHg and the pulse at 70-90 beats/min. The pathological examination of the surgical specimen showed a poorly differentiated T3N0 tumor. The patient had an uneventful recovery without aneurysm rupture, and was discharged from hospital on postoperative day 15 after 3 d adjuvant chemotherapy with oxaliplatin combined with calcium folinate and fluorouracil. The patient was given six courses of adjuvant chemotherapy in 6 mo, without recurrence or metastasis, and the aneurysm was still stable after 2 years follow-up.

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Aortic Morphology Following Endovascular Repair of Acute and Chronic Type B Aortic Dissection: Implications for Management

Cited by 175 publications

References 18 publications

Aortic Pathology Determines Midterm Outcome After Endovascular Repair of the Thoracic Aorta

Aortic Pathology Determines Midterm Outcome After Endovascular Repair of the Thoracic Aorta

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Surgery for rare aneurysm associated with colorectal cance

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