Own Clinical Observations of Treatment Outcome in Acute Type B Aortic Dissection

Abstract

the aim of the study was to analyse early results of treatment of acute type B aortic dissection. material and methods. 59 patients, treated between 1998 and 2011, were divided into four groups. Group I comprised ten patients in whom hybrid procedures were performed: extra-anatomical by-pass graft from the brachio-cephalic trunk to the left carotid artery in six patients, transposition of the left carotid artery to the right one in two patients, and reversed Y prosthesis from the brachio-cephalic trunk to both carotids in the remaining 2 patients, to facilitate stent-grafting. Group II comprised 13 patientsin whom endovascular procedures were performed (stent-grafting). Group III comprised 21 patients in whom conventional surgery was done. Group IV comprised 15 patients who were treated conservatively. Results. In group I, a very good clinical outcome, without complications, was achieved in six patients (60% of cases). The total mortality rate was 40%. One patient died on the operation table, following stent-grafting, due to the rupture of the aortic arch. Two patients died as a result of brain damage (cerebral aneurysm rupture in one, and ischemic stroke in the other). In one patient, an aorto-oesophageal fistula developed. In group II, one patient died during endovascular procedure. Another patient suffered from type 1 endoleak, requiring repeated endovascular surgery.In group III, 15 patients (72%) died. Moreover, four patients required acorrective cardiac surgery (Bentall procedure)which in three patients resulted in death. Thus, the total mortality rate in this group was as high as 85%. In group IV, the mortality rate was13%. Conclusions. We noticed a clear superiority of endovascular procedures over conventional surgeriesfor acute type B aortic dissection. Hybrid procedures for acute, complicated type B aortic dissection evidently reduce mortality and postoperative morbidity. Uncomplicated acute type B aortic dissections should be treated conservatively at intensivecare units.

Type B Aortic Dissection: A Review of Prognostic Factors and Meta-analysis of Treatment Options

“…In patients with mixed (complicated and uncomplicated) acute TBAD there was no significant difference between TEVAR and BMT groups regarding the cumu- lative 30-day all-cause mortality (six studies [61,78,80,[82][83][84][85]; TEVAR: n ϭ 775, BMT: n ϭ 4616, OR ϭ 0.878, P ϭ 0.410; I 2 ϭ 0.00, P ϭ 0.740) ( Fig. 1).…”

Endovascular Versus Medical Therapy for Uncomplicated Type B Aortic Dissection

“…In one study consisting of 13 patients, complications associated with TEVAR included wound infection (15.4%, n ¼ 2) and new-onset renal insufficiency (15.4%, n ¼ 2). 14 Among 5 studies for which the complication rates were compared between the 2 cohorts, the total cardiovascular complications in the TEVAR (28.2%, n ¼ 24) and BMT (30.4%, n ¼ 88) cohorts within a 2-year follow-up period were similar (P ¼ .35). 7,10,13-15…”

“…Only 6 articles met the inclusion criteria for analysis (Table 1). 7,10,[13][14][15][16] In the selected articles, 123 patients who underwent TEVAR and 566 patients who were treated with BMT were the participants of this review.…”