Endovascular Treatment of Type B Aortic Dissection: The Challenge of Late Success

Alves, Cláudia Maria Rodrigues; Fonseca, José Honório Palma da; Souza, José Augusto Marcondes de; Kim, Hyung Chun; Esher, Guilherme; Buffolo, Ênio

doi:10.1016/j.athoracsur.2009.02.050

Cited by 42 publications

(16 citation statements)

References 17 publications

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“…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.

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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.

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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.

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“…With this concept, aortic fenestration maneuvers or branch vessel revascularization with side-branch stents are usually not needed and almost obsolete. Complicated type B aortic dissection treated by TEVAR with an average follow-up time of 35.9 AE 28.5 months had a technical success rate of 99%, and a clinical success of 83% [23]. Late survival rates were higher than 80% at 2 years; inhospital mortality (6.6 vs. 3.3%, P ¼ 0.6), clinical success (75.5 vs. 82%, P ¼ 0.47), surgical conversion (8.8 vs. 3.3%, P ¼ 0.39), as well as late mortality (18 vs. 7%, P ¼ 0.2) were not different between acute and chronic type B dissection.…”

Section: Unstable Acute Type B Aortic Dissectionmentioning

confidence: 92%

Thoracic endovascular stent-graft therapy in aortic dissection

Akın

Kische

Rehders

et al. 2010

Current Opinion in Cardiology

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“…7,[31][32][33][34] Although it is often difficult to compare retrospective series, we tried to identify common ground in contemporary reports (Table IV). The average rates for mortality and morbidity approach that of medical management.…”

Section: Management Of Aads Complicated By Malperfusion Remains One Omentioning

confidence: 99%

Endovascular management of acute aortic dissections

O’Donnell

Geotchues

Beavers

et al. 2011

Journal of Vascular Surgery

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Endovascular Treatment of Type B Aortic Dissection: The Challenge of Late Success

Cited by 42 publications

References 17 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

Thoracic endovascular stent-graft therapy in aortic dissection

Endovascular management of acute aortic dissections

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