Endovascular Treatment for Chronic Type B Dissection:<b>Limitations of Short Stent-Grafts Revealed at Midterm Follow-up</b>

Manning, Brian J.; Dias, Nuno; Ohrlander, Tomas; Malina, Martin; Sonesson, Björn; Resch, Timothy; Ivancev, Krassi

doi:10.1583/09-2717.1

Cited by 34 publications

(31 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent data on endovascular repair of chronic complicated TBAD reveal excellent procedural and survival outcomes, but at the expense of further re-interventions. The rates of stroke following endovascular-based repair ranged between 0% to 5%, it was 0% to 2% for paraplegia, up to 14% procedure-related mortality (20)(21)(22)(23)(24)(25)58,60,(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74) (Table 7).…”

Section: Medical Managementmentioning

confidence: 99%

Conservative management versus endovascular or open surgery in the spectrum of type B aortic dissection

Yuan¹,

Mitsis²,

Ghonem³

et al. 2018

J. Vis. Surg.

View full text Add to dashboard Cite

Background: Type B aortic dissection is a life-threatening acute aortic condition often with acute ischemic signs or symptoms. With initial management focusing on alleviating malperfusion and pain, and avoiding propagation of dissection or rupture both systolic blood and pulse pressure should be reduced initially by an aggressive medical approach. In the setting of persistent signs of complications endovascular strategies have replaced open surgery and led to a fourfold increase in early survival and better long-term outcomes. Results: Our manuscript has summarized data collected over 12 years on management specific outcomes in the setting of distal aortic dissection and provides an up-to-date interpretation of the published evidence.For complicated cases, treated acutely, the 30-day or in-hospital mortality was 7.3% when managed by endovascular means, whereas the pooled rate for 30-day or in-hospital mortality was 19.0% when subjected to open repair. For acute uncomplicated type B dissection usually treated with blood pressure lowering medications, the pooled 30-day or in-hospital mortality rate was 2.4%. Survival rates at 5 years averaged at 60% (40% mortality). Freedom from any aortic event ranged from 34.0% to 83.9%, underlining an inherent risk of progression and late complications. For chronic complicated type B dissection, the rates of stroke, paraplegia and operative mortality following endovascular repair ranged from 5% to 13%, 2% to 13% and 2 to 13%, respectively, while 5-year survival rates after open repair ranged from 60% to 90%. In chronic uncomplicated type B dissection almost 90% of patients survive initial hospitalization and were subjected to medical management with a 5-year survival of 50-80%. However, up to 20-55% of medically treated patients develop aneurysmal degeneration after 5 years with an unknown risk of rupture.Conclusions: Currently, the less invasive strategy of endovascular repair (as compared to open surgery) provides improved 30-day or in-hospital survival in the setting of complicated acute type B aortic dissection and may seek broad application. Open surgical aortic reconstruction should be left to experienced aortic centres if endovascular management is not an option.

show abstract

Section: Medical Managementmentioning

confidence: 99%

Conservative management versus endovascular or open surgery in the spectrum of type B aortic dissection

Yuan¹,

Mitsis²,

Ghonem³

et al. 2018

J. Vis. Surg.

View full text Add to dashboard Cite

show abstract

“…In the case of replacement of the descending thoracic aorta, the intercostal arteries were usually not reconstructed, except in patients with Marfan syndrome. However, in the case of replacement of the thoracoabdominal aorta, [2][3] pairs of intercostal arteries between Th8 and L3 were reconstructed. The flow rate in the lower body was approximately 2.0 l·min -1 ·m 2 during distal clamping.…”

Section: Operative Techniquesmentioning

confidence: 99%

“…Although early and midterm results show that endovascular treatment is effective, new intimal tears occur at the end of the stent graft because of narrowness and limited flexibility of the true lumen; these tears lead to re-intervention or rupture during the follow-up period. [1][2][3] Recently, Xu et al reported that to avoid a proximal endoleak, the distance between the entry tear and opening of the left subclavian artery should be more than 10 mm. Furthermore, to avoid a distal endoleak, they recommended the use of a tapered stent graft.…”

Section: Commentmentioning

confidence: 99%

“…It has been shown that endovascular treatment results in a new intimal tear at the end of the stent graft due to the narrowness and limited flexibility of the true lumen. [1][2][3] On the other hand, extensive surgical aortic replacement using hypothermic circulatory arrest is highly invasive, and its operative mortality remains high. [4][5][6][7] Recently at our institution, we used a novel surgical technique, employing the left axillary artery for perfusion inflow.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Recent Outcomes of Surgery for Chronic Type B Aortic Dissection

Takagi

Ando

Higuchi

et al. 2010

Annals of Vascular Diseases

View full text Add to dashboard Cite

Results: Open proximal anastomosis was performed in 22 patients (56%). In 24 cases (62%), grafts were anastomosed to the true lumen of the peripheral aorta. The early overall mortality rate was 3% (1 patient). Permanent cerebral infarction occurred in 2 patients (5%); and paraparesis, in 1 patient (3%). The KaplanMeier survival estimates were 91% at 2 years and 88% at 5 years. Conclusion: Our surgical strategy is associated with excellent short-term and midterm outcomes. Although further investigation is needed, this strategy may be useful for patients with chronic type B dissection.

show abstract

“…Endograft erosion through the dissection septum has been described, mandating long-term follow-up. 14,15 This problem may be related to oversizing as well as to grafts with bare metal extensions.…”

Section: Demographicsmentioning

confidence: 99%

Endovascular management of acute aortic dissections

O’Donnell

Geotchues

Beavers

et al. 2011

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

Endovascular Treatment for Chronic Type B Dissection:Limitations of Short Stent-Grafts Revealed at Midterm Follow-up

Abstract: Endovascular stent-graft treatment is effective therapy for chronic type B dissection patients with false lumen aneurysms. Erosion of the dissection membrane, causing proximal or distal endoleak, is the most common reason for re-intervention during midterm follow-up.

Cited by 34 publications

References 10 publications

Conservative management versus endovascular or open surgery in the spectrum of type B aortic dissection

Conservative management versus endovascular or open surgery in the spectrum of type B aortic dissection

Recent Outcomes of Surgery for Chronic Type B Aortic Dissection

Endovascular management of acute aortic dissections

Contact Info

Product

Resources

About