Endovascular Stent–Graft Placement for the Treatment of Acute Aortic Dissection

Dake, Michael D.; Kato, Noriyuki; Mitchell, R. Scott; Semba, Charles P.; Razavi, Mahmood K.; Shimono, Takatsugu; Hirano, Toshio; Takeda, Kan; Yada, Isao; Miller, D. Craig

doi:10.1056/nejm199905203402004

Cited by 1,153 publications

(755 citation statements)

References 26 publications

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“…El objetivo del implante de una endoprótesis en las disecciones es cerrar el desgarro proximal de la aorta, redireccionando el flujo por el lumen verdadero, lo que promovería la trombosis del falso lumen y la remodelación aórtica con menor morbimortalidad que la cirugía convencional 16,17 .…”

Section: Discussionunclassified

Manejo endovascular de las complicaciones agudas de la disección aórtica tipo B

et al. 2010

Rev. méd. Chile

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Section: Discussionunclassified

Manejo endovascular de las complicaciones agudas de la disección aórtica tipo B

et al. 2010

Rev. méd. Chile

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“…29) One recent study reported that 19 patients with descending thoracic AAD successfully underwent endovascular stent-graft deployment without complications. 30) Use of an EVS device minimizes invasiveness and blood loss, operative time, length of hospital stay, and complications, while increasing patient satisfaction. In our study, 5 patients were treated with endovascular devices, and all of them have survived without major complications in the early phase.…”

Section: Discussionmentioning

confidence: 99%

<b>Newly Diagnosed Acute Aortic Dissection</b>

et al. 2005

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SUMMARYThe objective of the present study was to examine cases of acute aortic dissection in order to analyze the clinical and diagnostic findings, and to summarize their treatment modalities, as well as their hospital outcomes.Between July 1998 and June 1999, we prospectively studied patients who were newly diagnosed as having acute aortic dissection at 25 hospitals in Mie prefecture. These cases were examined for their demographics, the characteristics of the clinical findings, diagnostic methods, treatment modalities according to the type of aortic dissection, and the early morbidity and mortality of the hospital outcomes.Of 66 newly diagnosed aortic dissections (43 males), 30 were type A and 36 were type B. Seventy-six percent of the cases arrived at a medical facility within 6 hours from the onset of symptoms. Frequent initial symptoms and clinical findings were pain in 95.5%, cardiac arrest and/or hypotension in 21%, pericardial effusion in 29%, pleural effusion in 25%, and neurological signs in 30%. Twenty-one patients underwent surgical repair, 36 were treated medically, and 5 underwent endovascular stenting. Overall early mortality was 12.1%, which included 2 DOA. Fifty percent of these deaths occurred within 48 hours, and 63% by 72 hours of the initial event.In spite of the relatively rare incidence of acute aortic dissection in our study, the calculated incidence was 4.0/100,000/year. The overall mortality rate was relatively low compared to the figures reported in the literature, suggesting the earliest possible diagnosis and timely intervention are critically important to attain successful outcomes. (Int Heart J 2005; 46: 1083-1098

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“…Another study found that death among patients who underwent stent-graft placement was rarely directly related to the endovascular procedure but rather due to nonreversible ischemic changes compounded by patients' comorbid conditions. 65 The same can be said of deaths after cardiovascular surgery; however, stent enthusiasts argue that the need to cross-clamp the aorta during open aortic replacement compounds the ischemic injury to organs that have already been malperfused. Further study with appropriate controls is needed to evaluate these treatment modalities.…”

Section: Endovascular Therapy For Acute Aortic Syndromesmentioning

confidence: 99%

Acute Aortic Syndromes and Thoracic Aortic Aneurysm

Ramanath

Sundt

et al. 2009

Mayo Clinic Proceedings

190

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Acute and chronic aortic diseases have been diagnosed and studied by physicians for centuries. Both the diagnosis and treatment of aortic diseases have been steadily improving over time, largely because of increased physician awareness and improvements in diagnostic modalities. This comprehensive review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (and its variants intramural hematoma and penetrating aortic ulcers) and thoracic aortic aneurysms. Literature searches of the PubMed database were conducted using the following keywords: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies performed within the past 20 years were included in the review; however, most data are from the past 15 years. and studied by physicians for centuries. Descriptions of such pathologic conditions of the aorta as aneurysm and dissection date back as early as the 2nd century during the time of Galen, whose discoveries were largely made through studies of apes. More "recent" reports were described by Vesalius in 1557, followed by Nichols in 1732, who detailed the process of aortic dissection. In 1761, Morgagni reported detailed pathologic features of a patient with a ruptured aorta. 1 However, our true understanding of aortic pathology began with the dissertation by Shennan 2 in 1934, which included a description of penetrating atheromatous plaques of the thoracic aorta. His report was followed by the first successful management of aortic dissection by DeBakey in 1955. 1 Since then, our knowledge of the pathologic conditions of the aorta has grown considerably and continues to evolve with ongoing research into the pathophysiology of these conditions, technological advances in the modes of detection, and improved therapeutic options. Clinical databases, such as the International Registry of Acute Aortic Dissection (IRAD), the largest current registry for acute aortic syndromes, have also contributed tremendously to our knowledge of acute aortic pathology.For the practicing clinician, knowledge of aortic disease is paramount because patients with aortic conditions contribute significantly to the overall mortality from cardiovascular disease. This review discusses the pathophysiology, epidemiology, presentation, diagnosis, and therapeutic options for several forms of acute and chronic aortic pathology: aortic dissection (including its variants intramural hematoma [IMH] and penetrating atheromatous aortic ulcer) and thoracic aortic aneurysm (TAA). Literature searches were performed of the PubMed database using the following key words: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies conducted within the past 15 years, along with some data from years prior, were included in this review.

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Endovascular Stent–Graft Placement for the Treatment of Acute Aortic Dissection

Abstract: These initial results suggest that stent-graft coverage of the primary entry tear may be a promising new treatment for selected patients with acute aortic dissection. This technique requires further evaluation, however, to assess its therapeutic potential fully.

Cited by 1,153 publications

References 26 publications

Manejo endovascular de las complicaciones agudas de la disección aórtica tipo B

Manejo endovascular de las complicaciones agudas de la disección aórtica tipo B

<b>Newly Diagnosed Acute Aortic Dissection</b>

Acute Aortic Syndromes and Thoracic Aortic Aneurysm

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