Factors Associated With Increased Mortality After Isolated Abdominal Aortic Dissection Repair

Baldawi, Mohanad; Baldawi, Mustafa; Krafcik, Brianna M.; Al-Jubouri, Mustafa; Markowiak, Stephen; Osman, Mohamed; Brunicardi, F. Charles; Nazzal, Mustafa

doi:10.1016/j.avsg.2019.03.038

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…On the other hand, postoperative hypoxemia is quite common in patients with AAD and is associated with poor clinical outcomes [ 28 ]. Previous studies have shown that AAD patients complicated with respiratory diseases such as chronic obstructive pulmonary disease (COPD) are more likely to have hypoxemia or develop into acute respiratory failure after surgery, which has been proved to be an independent predictor of mortality in AAD [ 29 , 30 ]. Besides, patients with respiratory diseases such as COPD, asthma and tuberculosis accompanied with an increased WBCc have a higher mortality rate [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Admission white blood cell count predicts post-discharge mortality in patients with acute aortic dissection: data from the MIMIC-III database

Zhang

Bai

et al. 2021

BMC Cardiovasc Disord

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Background Inflammation underlies both the pathogenesis and prognosis in patients with acute aortic dissection (AAD). This study aimed to assess the association of ICU admission of white blood cell count (WBCc) with post-discharge mortality in these patients. Methods Clinical data were extracted from the MIMIC-III V1.4 database. After adjusted to covariables, Cox regression analysis and Kaplan–Meier survival curve were performed to determine the relationship between WBCc on admission and post-discharge mortality (30-day, 90-day, 1-year and 5-year) in AAD patients. Subgroup analysis and receiver operating characteristic (ROC) curve analysis were used to test the performance of WBCc in predicting mortality in AAD patients. Results A total of 325 eligible patients were divided into 2 groups: normal-WBCc group (≤ 11 k/uL) and high-WBCc group (> 11 K/uL). In univariate Cox regression analysis, high WBCc was significant risk predictor of 30-day, 90-day, 1-year and 5-year mortality [hazard ratio (HR), 95% CI, P 2.58 1.36–4.91 0.004; 3.16 1.76–5.70 0.000; 2.74 1.57–4.79 0.000; 2.10 1.23–3.54 0.006]. After adjusting for age and other risks, high WBCc remained a significant predictor of 30-day, 90-day and 1-year mortality in AAD patients (HR, 95% CI, P 1.994 1.058–3.76 0.033; 2.118 1.175–3.819 0.013; 2.37 1.343–4.181 0.003). The area under ROC curve of WBCc for predicting 30-day, 90-day, 1-year and 5-year mortality were 0.69, 0.70, 0.66 and 0.61, respectively. The results from subgroups analysis showed that there was no interaction in most strata and patients who were younger than 69 years of age or had history of respiratory disease with an elevated WBCc had an excess risk of 30-day mortality (HR, 95% CI, P 3.18 1.41–7.14 0.005; 3.84 1.05–14.13 0.043). Conclusions Higher than normal WBCc on admission may predict post-discharge mortality in patients with AAD.

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Section: Discussionmentioning

confidence: 99%

Admission white blood cell count predicts post-discharge mortality in patients with acute aortic dissection: data from the MIMIC-III database

Zhang

Bai

et al. 2021

BMC Cardiovasc Disord

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“…The straight graft in these studies was reported to seal the IAAD without iliac artery dissection. 9 In our study, 5 patients had stent grafts in iliac arteries to assist sealing the simultaneous iliac dissections, 3 unilateral and 2 bilateral with kissing technique (Supplemental Figure 4); this technique has been used for aortoiliac stenosis 19 but rarely reported in the treatment of IAAD. 15 We put more emphasis on Di, the closest distance between the aortic bifurcation and the entry tears, including the entry tears in iliac arteries; because of increased risk of endoleak, a straight graft, with or without a stent graft in the iliac artery, is not recommended when Di < 15 mm.…”

Section: Discussionmentioning

confidence: 92%

“…15 We put more emphasis on Di, the closest distance between the aortic bifurcation and the entry tears, including the entry tears in iliac arteries; because of increased risk of endoleak, a straight graft, with or without a stent graft in the iliac artery, is not recommended when Di < 15 mm. Conservative treatment with antihypertensive and analgesic therapy is still the main treatment in most regions, especially for the patients with chronic and asymptomatic IAAD 1,5,9,20 ; conservative management was also offered to all patients in this study. To date, the largest retrospective study of IAAD was reported by Kang et al, 3 including 210 patients, with all of these patients being treated conservatively initially; during 2 years' follow-up, only 1.4% of patients had complete aortic remodeling and 81.9% had no detectable remodeling, but 8.7% had false lumen enlargement and 6.5% had progression that was associated with an all-cause mortality of 16.7%.…”

Section: Discussionmentioning

confidence: 99%

“…With the increasing popularity and efficacy of endovascular treatment, the number of patients with open surgery has been diminishing, 1,7,9,10 with open surgery only reserved for cases that are unsuitable for endovascular treatment such as false lumen rupture. 9 There is no study yet published comparing outcomes of open surgery and endovascular treatment for IAAD. Open surgery seems to be associated with higher 30 day mortality (9%), increased long-term mortality (12%), and longer hospital stays 1,7,10 compared with endovascular therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, IAAD has been mainly treated conservatively 2,3 or with aortic replacement via open surgery. 8,9 However, conservative management may result in progression of the disease, including aortic rupture, unremitting symptoms, or limb or spinal cord ischemia, leading to high rates of mortality and reintervention. 1,6,10 Endovascular therapy has been used to treat IAAD in recent years 6,11–15 ; however, with the paucity of robust evidence-based data, there is no clear consensus regarding the optimal treatment for IAAD.…”

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confidence: 99%

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Similar Midterm Clinical Outcomes and Aortic Remodeling in Bifurcated and Straight Aortic Stent Grafts Used to Treat Isolated Abdominal Aortic Dissection

Wang

Shu

et al. 2021

J Endovasc Ther

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Purpose: The optimal treatment for isolated abdominal aortic dissection (IAAD) is currently unknown. We compared the effects of straight and bifurcated aortic stent grafts on postoperative aortic remodeling in patients with IAAD. Materials and Methods: From February 2012 to December 2019, 57 patients with IAAD were treated using endovascular methods, including either a bifurcated or a straight aortic stent graft. The clinical features, risk factors, computed tomography angiograms, midterm follow-up results, and aortic remodeling of these patients were reviewed and analyzed. Results: In total, 44 (77%) patients were treated with a bifurcated graft and 13 (23%) patients were treated with a straight graft. Patients treated with straight grafts had fewer common iliac arteries involved (38% vs 73%, p=0.023), the dissection length was shorter (76.3 ± 40.0 vs 116.2 ± 56.7 mm, p=0.011), and the preoperative aortic diameter (26.0 ± 5.6 vs 35.2 ± 12.1 mm) and the false lumen diameter (13.1 ± 5.2 vs 21.2 ± 11.3 mm) were smaller. During the procedure, there were 3 (5.3%) type I endoleaks, 1 (1.8%) surgical conversion and 1 (1.8%) partial renal artery coverage without perioperative mortality. Patients with straight grafts had shorter operative time (96.5 ± 24.4 vs 144.2 ± 49.0 minutes, p<0.0001). The median follow-up duration was 37.6 ± 21.0 (range = 3–89) months with 1 (1.8%) aortic-related death. Type A aortic dissection occurred in 1 (1.8%) patient. New descending aortic dissection occurred in 3 (5.3%) patients, and 1 patient advanced to type A aortic dissection 3 months later. Two (3.5%) patients had limb occlusion. There was no significant difference in aortic remodeling, survival, and freedom from all adverse events between the 2 treatment strategies. Conclusions: Endovascular treatment provides a safe, minimally invasive treatment for IAAD in midterm follow-up. Compression of the true lumen at the aortic bifurcation is the main concern after treatment with a bifurcated graft. Straight grafts are an excellent alternative for some patients, with the benefit of reduced procedural time, effective aortic remodeling, and excellent clinical prognosis. More experience is needed to offer clear recommendations for making treatment decisions as well as determine long-term effectiveness and durability.

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Postoperative acute kidney injury and early and long-term mortality in acute aortic dissection patients

Meng¹,

Li²,

Lihua³

et al. 2021

Medicine

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Objective: To evaluate the impact of postoperative acute kidney injury (AKI) on early and long-term mortality in patients with acute aortic dissection by conducting a meta-analysis. Methods: An extensive literature search was performed in PubMed and Embase databases until February 15, 2020. Observational studies that reported the associations between postoperative AKI and early (in-hospital and within 30 days) or long-term mortality in patients with acute aortic dissection were included. Results: Seven studies comprising 1525 acute aortic dissection patients were identified. A random effect meta-analysis showed that postoperative AKI was significantly associated with higher risk of long-term mortality (risk ratio [RR] 2.32; 95% confidence interval [CI] 1.50–3.59). Subgroup analysis revealed that the pooled RR of long-term mortality was 1.42 (95% CI 0.90–2.22) for stage 1 AKI, 1.72 (95% CI 0.95–3.12) for stage 2 AKI, and 4.46 (95% CI 2.72–7.32) for stage 3 AKI, respectively. Furthermore, postoperative stage 3 AKI was associated with an increased risk of early mortality (RR 11.3; 95% CI 4.2–30.5). Conclusions: This meta-analysis provided clinical evidence that postoperative stage 3 AKI is associated with higher risk of early and long-term mortality, even after adjusting important confounding factors. However, the current findings should be interpreted with caution due to the retrospective nature and limited number of studies analyzed.

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Factors Associated With Increased Mortality After Isolated Abdominal Aortic Dissection Repair

Cited by 5 publications

References 17 publications

Admission white blood cell count predicts post-discharge mortality in patients with acute aortic dissection: data from the MIMIC-III database

Admission white blood cell count predicts post-discharge mortality in patients with acute aortic dissection: data from the MIMIC-III database

Similar Midterm Clinical Outcomes and Aortic Remodeling in Bifurcated and Straight Aortic Stent Grafts Used to Treat Isolated Abdominal Aortic Dissection

Postoperative acute kidney injury and early and long-term mortality in acute aortic dissection patients

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