ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
 QUICK SEARCH:   [advanced]


     


This Article
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Elefteriades, J. A.
Right arrow Articles by Hammond, G. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Elefteriades, J. A.
Right arrow Articles by Hammond, G. L.

The Annals of Thoracic Surgery, Vol 53, 11-20, Copyright © 1992 by The Society of Thoracic Surgeons


ARTICLES

Long-term experience with descending aortic dissection: the complication-specific approach

JA Elefteriades, J Hartleroad, RJ Gusberg, AM Salazar, HR Black, GS Kopf, JC Baldwin and GL Hammond
Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT 06510.

We analyzed long-term results in 71 patients (45 men and 26 women) treated over 17 years for documented descending aortic dissection. Forty-nine patients were treated medically and 22, surgically. Actuarial survival was 65% at 1 year, 57% at 3 years, 50% at 5 years, and 28% at 10 years for the whole group. For the group treated medically, survival was 73%, 63%, 58%, and 25% at 1 year, 3 years, 5 years, and 10 years, respectively, and for the group treated surgically, 47%, 40%, and 28% at 1 year, 3 years, and 5 years, respectively. Ten (20.4%) of the 49 medically treated patients died early (5 of rupture), and 14 (28.6%) died late (8 of dissection). Five medically treated patients crossed over to surgical management for complications of dissection. Among the surgically treated patients, 6 underwent standard graft replacement of the proximal descending aorta, 8 underwent the fenestration procedure (with a standardized retroperitoneal abdominal approach), and 4 underwent the thromboexclusion operation. Specific analysis of fenestration in 14 patients (including some with persistent descending aortic dissection after replacement of the ascending aorta for dissection) found it to be safe and effective. Actuarial survival after fenestration was 77%, 77%, and 53% at 1 year, 3 years, and 5 years, respectively. Thromboexclusion was found effective, and postoperative studies confirmed thrombosis of the descending aorta with preservation of the lowest intercostal arteries. Fifteen of the 21 surviving medically treated patients agreed to return for follow-up imaging. Nine had thrombosis of the false lumen. An interesting radiographic finding was that 4 of the 15 restudied patients had a saccular aneurysm in the aorta at the level of the left subclavian artery. We recommend a complication-specific approach to the management of descending aortic dissection. Uncomplicated dissection is treated medically, whereas complicated dissection is treated surgically, with realized rupture treated by standard graft replacement, limb ischemia treated by fenestration, and enlargement or impending rupture treated by thromboexclusion.


This article has been cited by other articles:


Home page
J Am Coll Cardiol IntvHome page
R. Fattori, T. T. Tsai, T. Myrmel, A. Evangelista, J. V. Cooper, S. Trimarchi, J. Li, L. Lovato, S. Kische, K. A. Eagle, et al.
Complicated Acute Type B Dissection: Is Surgery Still the Best Option?: A Report From the International Registry of Acute Aortic Dissection
J. Am. Coll. Cardiol. Intv., August 1, 2008; 1(4): 395 - 402.
[Abstract] [Full Text] [PDF]


Home page
PERSPECT VASC SURG ENDOVASC THERHome page
G. S. Oderich, J. M. Panneton, T. C. Bower, J. J. Ricotta, T. M. Sundt, S. Cha, and P. Gloviczki
Aortic Dissection With Aortic Side Branch Compromise: Impact of Malperfusion on Patient Outcome
Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2008; 20(2): 190 - 200.
[Abstract] [PDF]


Home page
CirculationHome page
W. Swee and M. D. Dake
Endovascular Management of Thoracic Dissections
Circulation, March 18, 2008; 117(11): 1460 - 1473.
[Full Text] [PDF]


Home page
Card Surg AdultHome page
T. B. Reece, G. R. Green, and I. L. Kron
Aortic Dissection
Card. Surg. Adult, January 1, 2008; 3(2008): 1195 - 1222.
[Full Text]


Home page
J Am Coll CardiolHome page
J.-M. Song, S.-D. Kim, J.-H. Kim, M.-J. Kim, D.-H. Kang, J. B. Seo, T.-H. Lim, J. W. Lee, M.-G. Song, and J.-K. Song
Long-Term Predictors of Descending Aorta Aneurysmal Change in Patients With Aortic Dissection
J. Am. Coll. Cardiol., August 21, 2007; 50(8): 799 - 804.
[Abstract] [Full Text] [PDF]


Home page
PERSPECT VASC SURG ENDOVASC THERHome page
S. L. Kahn and M. D. Dake
Stent Graft Management of Stable, Uncomplicated Type B Aortic Dissection
Perspectives in Vascular Surgery and Endovascular Therapy, June 1, 2007; 19(2): 162 - 169.
[Abstract] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
R. Fattori, C. A. Nienaber, H. Rousseau, J.-P. Beregi, R. Heijmen, M. Grabenwoger, P. Piquet, L. Lovato, C. Dabbech, S. Kische, et al.
Results of endovascular repair of the thoracic aorta with the Talent Thoracic stent graft: The Talent Thoracic Retrospective Registry.
J. Thorac. Cardiovasc. Surg., August 1, 2006; 132(2): 332 - 339.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
T. T. Tsai, C. A. Nienaber, and K. A. Eagle
Acute Aortic Syndromes
Circulation, December 13, 2005; 112(24): 3802 - 3813.
[Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
F. J. Criado, O. R. Abul-Khoudoud, G. S. Domer, C. McKendrick, M. Zuzga, N. S. Clark, K. Monaghan, and M. F. Barnatan
Endovascular Repair of the Thoracic Aorta: Lessons Learned
Ann. Thorac. Surg., September 1, 2005; 80(3): 857 - 863.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
Y. Moizumi, N. Motoyoshi, K. Sakuma, and S. Yoshida
Axillary Artery Cannulation Improves Operative Results for Acute Type A Aortic Dissection
Ann. Thorac. Surg., July 1, 2005; 80(1): 77 - 83.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
C. F. Russo, A. Garatti, M. Puttini, and E. Vitali
Distal aortic arch aneurysm after endovascular stent graft repair for type B chronic aortic dissection
J. Thorac. Cardiovasc. Surg., October 1, 2004; 128(4): 634 - 636.
[Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
L. F. Duebener, P. Lorenzen, G. Richardt, M. Misfeld, A. Notzold, F. Hartmann, H.-H. Sievers, and V. Geist
Emergency Endovascular Stent-Grafting for Life-Threatening Acute Type B Aortic Dissections
Ann. Thorac. Surg., October 1, 2004; 78(4): 1261 - 1266.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
S. Onitsuka, H. Akashi, K. Tayama, T. Okazaki, K. Ishihara, S. Hiromatsu, and S. Aoyagi
Long-Term Outcome and Prognostic Predictors of Medically Treated Acute Type B Aortic Dissections
Ann. Thorac. Surg., October 1, 2004; 78(4): 1268 - 1273.
[Abstract] [Full Text] [PDF]


Home page
Eur. J. Cardiothorac. Surg.Home page
H.-Y. Yu, Y.-S. Chen, S.-C. Huang, S.-S. Wang, and F.-Y. Lin
Late outcome of patients with aortic dissection: study of a national database
Eur. J. Cardiothorac. Surg., May 1, 2004; 25(5): 683 - 690.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
R. H. Mehta, E. Bossone, A. Evangelista, P. T. O'Gara, D. E. Smith, J. V. Cooper, J. K. Oh, J. L. Januzzi, S. Hutchison, D. Gilon, et al.
Acute type B aortic dissection in elderly patients: clinical features, outcomes, and simple risk stratification rule
Ann. Thorac. Surg., May 1, 2004; 77(5): 1622 - 1628.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
C. A. Nienaber and K. A. Eagle
Aortic Dissection: New Frontiers in Diagnosis and Management: Part II: Therapeutic Management and Follow-Up
Circulation, August 12, 2003; 108(6): 772 - 778.
[Full Text] [PDF]


Home page
HeartHome page
R E Bell and J F Reidy
Endovascular treatment of thoracic aortic disease
Heart, August 1, 2003; 89(8): 823 - 824.
[Full Text] [PDF]


Home page
Card Surg AdultHome page
G. R. Green and I. L. Kron
Aortic Dissection
Card. Surg. Adult, January 1, 2003; 2(2003): 1095 - 1122.
[Full Text]


Home page
Card Surg AdultHome page
S. D. Moffatt and R. S. Mitchell
Endovascular Stent Management of Thoracic Aneurysms and Dissections
Card. Surg. Adult, January 1, 2003; 2(2003): 1191 - 1204.
[Full Text]


Home page
Eur. J. Cardiothorac. Surg.Home page
M. Genoni, M. Paul, R. Tavakoli, A. Kunzli, M. Lachat, K. Graves, B. Seifert, and M. Turina
Predictors of complications in acute type B aortic dissection
Eur. J. Cardiothorac. Surg., July 1, 2002; 22(1): 59 - 63.
[Abstract] [Full Text] [PDF]


Home page
ChestHome page
I. A. Khan and C. K. Nair
Clinical, Diagnostic, and Management Perspectives of Aortic Dissection*
Chest, July 1, 2002; 122(1): 311 - 328.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
R. Erbel, F. Alfonso, C. Boileau, O. Dirsch, B. Eber, A. Haverich, H. Rakowski, J. Struyven, K. Radegran, U. Sechtem, et al.
Diagnosis and management of aortic dissection: Task Force on Aortic Dissection, European Society of Cardiology
Eur. Heart J., September 2, 2001; 22(18): 1642 - 1681.
[PDF]


Home page
RadiologyHome page
S.-G. Kang, D. Y. Lee, M. Maeda, E. S. Kim, D. Choi, B.-O. Kim, H. K. Yoon, K. B. Sung, and H.-Y. Song
Aortic Dissection: Percutaneous Management with a Separating Stent-Graft—Preliminary Results
Radiology, August 1, 2001; 220(2): 533 - 539.
[Abstract] [Full Text] [PDF]


Home page
Eur. J. Cardiothorac. Surg.Home page
V. Rampoldi, S. Trimarchi, V. Tolva, and P. Righini
Proximal pseudoaneurysm of ascending-abdominal aortic bypass
Eur. J. Cardiothorac. Surg., April 1, 2001; 19(4): 531 - 533.
[Abstract] [Full Text] [PDF]


Home page
PERSPECT VASC SURG ENDOVASC THERHome page
T. E. Rasmussen and J. M. Panneton
Ischemic Complications of Distal Aortic Dissections: Open Surgical or Endovascular Management?
Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 2001; 14(2): 57 - 71.
[Abstract] [PDF]


Home page
RadiologyHome page
B. V. Czermak, P. Waldenberger, G. Fraedrich, A. H. Dessl, K. E. Roberts, R. J. Bale, R. Perkmann, and W. R. Jaschke
Treatment of Stanford Type B Aortic Dissection with Stent-Grafts: Preliminary Results
Radiology, November 1, 2000; 217(2): 544 - 550.
[Abstract] [Full Text]


Home page
Med Decis MakingHome page
D. Katz, D. Payne, and S. Pauker
Early Surgery versus Conservative Management of Dissecting Aneurysms of the Descending Thoracic Aorta
Med Decis Making, October 1, 2000; 20(4): 377 - 390.
[Abstract] [PDF]


Home page
Ann. Thorac. Surg.Home page
R. B. Griepp, M. A. Ergin, J. D. Galla, S. L. Lansman, J. N. McCullough, K. H. Nguyen, J. J. Klein, and D. Spielvogel
Natural history of descending thoracic and thoracoabdominal aneurysms
Ann. Thorac. Surg., June 1, 1999; 67(6): 1927 - 1930.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
J. A. Elefteriades, C. J. Lovoulos, M. A. Coady, G. Tellides, G. S. Kopf, and J. A. Rizzo
Management of descending aortic dissection
Ann. Thorac. Surg., June 1, 1999; 67(6): 2002 - 2005.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
S. M. Slonim, D. C. Miller, R. S. Mitchell, C. P. Semba, M. K. Razavi, and M. D. Dake
PERCUTANEOUS BALLOON FENESTRATION AND STENTING FOR LIFE-THREATENING ISCHEMIC COMPLICATIONS IN PATIENTS WITH ACUTE AORTIC DISSECTION
J. Thorac. Cardiovasc. Surg., June 1, 1999; 117(6): 1118 - 1127.
[Abstract] [Full Text] [PDF]


Home page
NEJMHome page
M. D. Dake, N. Kato, R. S. Mitchell, C. P. Semba, M. K. Razavi, T. Shimono, T. Hirano, K. Takeda, I. Yada, and D. C. Miller
Endovascular Stent-Graft Placement for the Treatment of Acute Aortic Dissection
N. Engl. J. Med., May 20, 1999; 340(20): 1546 - 1552.
[Abstract] [Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
T. Juvonen, M. A. Ergin, J. D. Galla, S. L. Lansman, J. N. McCullough, K. Nguyen, C. A. Bodian, M. P. Ehrlich, D. Spielvogel, J. J. Klein, et al.
RISK FACTORS FOR RUPTURE OF CHRONIC TYPE B DISSECTIONS
J. Thorac. Cardiovasc. Surg., April 1, 1999; 117(4): 776 - 786.
[Abstract] [Full Text] [PDF]


Home page
PERSPECT VASC SURG ENDOVASC THERHome page
V. J. Weiss and R. B. Smith III
Peripheral Vascular Manifestations of Aortic Dissection: Recognition and Management
Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 1999; 10(2): 27 - 41.
[Abstract] [PDF]


Home page
Ann. Thorac. Surg.Home page
D. L.S. Morales, J. A. Quin, J. H. Braxton, G. L. Hammond, R. J. Gusberg, and J. A. Elefteriades
Experimental confirmation of effectiveness of fenestration in acute aortic dissection
Ann. Thorac. Surg., November 1, 1998; 66(5): 1679 - 1683.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
R. Pretre, N. Murith, D. Delay, and T. Kalonji
Surgical Management of Hemorrhage From Rupture of the Aortic Arch
Ann. Thorac. Surg., May 1, 1998; 65(5): 1291 - 1295.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
K. Ku, K. Nakayama, Y. Saitoh, S. Nosaka, T. Kitano, T. Hanada, H. Nagami, K. Yamada, and K. Minami
Long-Term Follow-up (8 to 17 Years) After Thromboexclusion Operation for Thoracic Aortic Aneurysms
Ann. Thorac. Surg., August 1, 1997; 64(2): 399 - 403.
[Abstract] [Full Text]


Home page
Ann. Thorac. Surg.Home page
J. H. Palma, D. R. Almeida, A. C. Carvalho, J. C. S. Andrade, and E. Buffolo
Surgical Treatment of Acute Type B Aortic Dissection Using an Endoprosthesis (Elephant Trunk)
Ann. Thorac. Surg., April 1, 1997; 63(4): 1081 - 1084.
[Abstract] [Full Text]


Home page
Ann. Thorac. Surg.Home page
H. Urayama, H. Ohtake, and Y. Watanabe
Long-Term Results of Flow Reversal and Thromboexclusion Method for Thoracic Aortic Aneurysm
Ann. Thorac. Surg., March 1, 1997; 63(3): 716 - 720.
[Abstract] [Full Text]


Home page
J. Thorac. Cardiovasc. Surg.Home page
M. A. Coady, J. A. Rizzo, G. L. Hammond, D. Mandapati, U. Darr, G. S. Kopf, and J. A. Elefteriades
WHAT IS THE APPROPRIATE SIZE CRITERION FOR RESECTION OF THORACIC AORTIC ANEURYSMS?
J. Thorac. Cardiovasc. Surg., March 1, 1997; 113(3): 476 - 491.
[Abstract] [Full Text]


Home page
Ann. Thorac. Surg.Home page
J. S. Schor, M. E. Yerlioglu, J. D. Galla, S. L. Lansman, M. A. Ergin, and R. B. Griepp
Selective Management of Acute Type B Aortic Dissection: Long-Term Follow-up
Ann. Thorac. Surg., May 1, 1996; 61(5): 1339 - 1341.
[Abstract] [Full Text]


Home page
Ann. Thorac. Surg.Home page
M. J. Perko, M. Norgaard, T. M. Herzog, P. S. Olsen, T. V. Schroeder, and G. Pettersson
Unoperated Aortic Aneurysm: A Survey of 170 Patients
Ann. Thorac. Surg., May 1, 1995; 59(5): 1204 - 1209.
[Abstract] [Full Text]


Home page
Ann. Thorac. Surg.Home page
M. Kato, T. Matsuda, M. Kaneko, T. Ueda, T. Kuratani, Y. Yoshioka, and K. Ohnishi
Experimental Assessment of Newly Devised Transcatheter Stent-Graft for Aortic Dissection
Ann. Thorac. Surg., April 1, 1995; 59(4): 908 - 914.
[Abstract] [Full Text]




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1992 by The Society of Thoracic Surgeons.