Aortic Dissection Limited to Abdominal Aorta: an Underrecognized Entity ?

Vermeersch, Nicolas; Hendriks, Jeroen; Lauwers, Patrick; Salgado, Rodrigo; Schil, Paul E. Van

doi:10.1080/00015458.2015.11681115

Cited by 7 publications

(6 citation statements)

References 2 publications

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“…In our literature review, 2,6,8,10,[15][16][17][18][19][20][21][22][23][24][25][26] symptomatic patients numbered 68%, and AAA or CTD coexisted in 47% and 6.4% of patients, respectively. Aortic rupture developed in 6.9% of the patients, and the iliac or visceral artery was involved in 48.4% and 11%, respectively (Table VI).…”

Section: Discussionmentioning

confidence: 99%

Treatment strategy based on the natural course of the disease for patients with spontaneous isolated abdominal aortic dissection

Kang

Kim

Heo

et al. 2017

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Treatment strategy based on the natural course of the disease for patients with spontaneous isolated abdominal aortic dissection

Kang

Kim

Heo

et al. 2017

Journal of Vascular Surgery

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“…Vermeersch et al reported 5 cases of asymptomatic IAAD treated conservatively with blood pressure control and strict follow-up. During the follow-up period, all patients remained symptomfree and the dissection length remained stable (7). Endovascular or surgical interventions are suggested in all patients with dissection and concomitant aortic aneurysm (aortic diameter exceeding 3 cm), or in patients with signs of aortic rupture, ischemic symptoms, and unremitting pain in a non-dilated aorta (5,6,8).…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of spontaneous isolated abdominal aortic dissection

Giribono

Ferrara

Spalla

et al. 2016

Acta Radiologica Open

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Isolated abdominal aortic dissection is a rare clinical disease representing only 1.3% of all dissections. There are a few case series reported in the literature. The causes of this pathology can be spontaneous, iatrogenic, or traumatic. Most patients are asymptomatic and symptoms are usually abdominal or back pain, while claudication and lower limb ischemia are rare. Surgical and endovascular treatment are two valid options with acceptable results. We herein describe nine cases of symptomatic spontaneous isolated abdominal aortic dissection, out of which four successfully were treated with an endovascular approach between July 2003 and July 2013. All patients were men, smokers, symptomatic (either abdominal or back pain or lower limb ischemia), with a history of high blood pressure, with a medical history negative for concomitant aneurysmatic dilatation or previous endovascular intervention. Diagnosis of isolated abdominal aortic dissection were established by contrast-enhanced computed tomography angiography (CTA) of the thoracic and abdominal aorta. All nine patients initially underwent medical treatment. In four symptomatic cases, non-responsive to medical therapy, bare-metal stents or stent grafts were successfully positioned. All patients completed a CTA follow-up of at least 12 months, during which they remained symptom-free. Endovascular management of this condition is associated with a high rate of technical success and a low mortality; therefore, it can be considered the treatment of choice when it is feasible.

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“…During follow up, other than two deaths before treatment and 35 deaths in the Kang et al 13 study with non-separated data, 21 deaths The overall 91% of IAADs were spontaneous, which is comparable to previous studies reporting dissection types (66.7e100%). 3,7,9,11,14,18,19,21,25,26 Hypertension, smoking, and hyperlipidaemia were the most common concomitant risk factors of IAAD, which could induce endothelial damage and a persistent inflammatory response to stimulate formation of atherosclerosis and spontaneous aortic dissection. 27,28 Therefore, all patients with IAAD should be advised on basic lifestyle interventions, including hypertension control, smoking cessation, and a decrease of salt and fat in diet.…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…According to the contemporary aortic dissection guidelines, 31,32 antihypertensive and analgesic therapy are the principal components of conservative treatment, which presents an evidence-based consensus among the individual studies. 3,7,10,15e18, 26 The use of a b-blocker and vasodilator is standard antihypertensive therapy to lower systolic blood pressure. However, the pooled re-intervention rate of 18% in the conservative group was higher than the ENDO and the OS group in the present meta-analysis.…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…However, compared with the previous meta-analysis of 92 patients, this review could provide better clinical guidance. 12 Second, because of the Initial conservative treatment Farber (2002) 7 Berthet (2003) 10 Trimarchi (2007) 3 Vermeersch (2015) 26 Bockler (2016) 15 Faries (2016) 16 Giribono (2016) 17 Wang GQ (2017) 18 LR Test: RE vs FE Chi 2 = 0.000, p = . )…”

Section: Clinical Outcomesmentioning

confidence: 99%

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Systematic Review and Meta-analysis of Current Literature on Isolated Abdominal Aortic Dissection

Yang

Han

Zhao

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis meta-analysis presents the pooled quantitative evidence of basic profiles, initial treatment strategies, and clinical outcomes in patients with isolated abdominal aortic dissection. Major findings suggest that appropriate initial treatment strategies can obtain acceptable clinical outcomes, with a 30 day mortality of 3%, a long term mortality of 8%, and a re-intervention rate of 8%. Endovascular repair or open surgery is necessary if patients match certain indications for intervention. Regular imaging surveillance should be provided for all patients, especially those treated conservatively, who appear to be most at risk of second intervention.Objective: To present the pooled quantitative evidence of basic profiles, initial treatment strategies, and clinical outcomes in patients with isolated abdominal aortic dissection (IAAD). Methods: A comprehensive systematic review and meta-analysis was performed of all available studies reporting IAAD, retrieved from the MEDLINE, Embase, and Cochrane Databases. The logistic normal random effect model was fitted using the generalised linear mixed model with random intercepts to calculate the pooled proportion estimates.Results: Seventeen studies with 482 patients were included in this meta-analysis. Male smokers with hyperlipidaemia and hypertension were the most prominent basic profile. IAADs were predominantly spontaneous and infrarenal, and roughly half were acute and symptomatic. Approximately 67% [95% confidence interval (CI) 42e86%] of patients were managed initially conservatively. In the overall population, the 30 day all cause mortality was 3% (95% CI 1e5%) and the long term mortality during follow up was 8% (95% CI 5e14%). Re-intervention during follow up occurred in 8% (95% CI 5e15%) of patients. In the subgroup analysis, patients with conservative treatment had a 30 day mortality of 1% (95% CI 0e8%), a long term mortality of 5% (95% CI 1e29%), and a re-intervention rate of 18% (95% CI 10e29%). Patients with open surgery had a 30 day mortality of 9% (95% CI 0e82%), a long term mortality of 12% (95% CI 4e31%), and a re-intervention rate of 9% (95% CI 1e44%). Patients with endovascular repair had a 30 day mortality of 2% (95% CI 0e10%), a long term mortality of 5% (95% CI 2e13%), a re-intervention rate of 6% (95% CI 3e 13%), and a persistent endoleak rate of 4% (95% CI 2e10%). Conclusion: Appropriate initial treatment strategies can be used to obtain acceptable clinical outcomes in patients with IAAD. Invasive intervention is necessary if patients match certain indications for intervention. Regular imaging surveillance should be provided for all patients, especially those treated conservatively.

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Aortic Dissection Limited to Abdominal Aorta: an Underrecognized Entity ?

Abstract: Based on our case series, IAAD remains a rare clinical condition with relative benign clinical course. Treatment was almost exclusively conservative. Recent publications state IAAD might be underrecognized and under-diagnosed compared to thoracic aortic dissections.

Cited by 7 publications

References 2 publications

Treatment strategy based on the natural course of the disease for patients with spontaneous isolated abdominal aortic dissection

Treatment strategy based on the natural course of the disease for patients with spontaneous isolated abdominal aortic dissection

Endovascular treatment of spontaneous isolated abdominal aortic dissection

Systematic Review and Meta-analysis of Current Literature on Isolated Abdominal Aortic Dissection

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