HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Cyrus J. Parsa Jacob N. Schroder Mani A. Daneshmand Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Parsa, C. J. Articles by Hughes, G. C. Search for Related Content PubMed PubMed Citation Articles by Parsa, C. J. Articles by Hughes, G. C. Related Collections Great vessels

---

Original Articles: Adult Cardiac

Midterm Results for Endovascular Repair of Complicated Acute and Chronic Type B Aortic Dissection

Department of Surgery, Duke University Medical Center, Durham, North Carolina

Accepted for publication September 15, 2009.

^_* Address correspondence to Dr Hughes, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Box 3051, Duke University Medical Center, Durham, NC 27710 (Email: gchad.hughes{at}duke.edu).

Presented at the Fifty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Austin, TX, Nov 5–8, 2008.

Background: Thoracic endovascular aortic repair (TEVAR) for the management of type B aortic dissections has become more commonplace despite some controversy. Results of endovascular management of complicated acute (<2 weeks from symptom onset) and chronic (>2 weeks) type B aortic dissection with a view towards determining safety, efficacy, and requirement for secondary procedures are reviewed.

Methods: Between June 2005 and November 2008, 55 patients (41 men) with a mean age of 59 ± 12 years (range, 31 to 77 years) underwent TEVAR for the management of complicated acute (n = 22) or chronic (n = 33) type B dissection. Indications in acute dissection included impending or frank rupture in 11 and malperfusion syndromes in 11; the indication in chronic dissections was aneurysmal degeneration in 33.

Results: Primary technical success was 100%. In-hospital and 30-day rates of death, stroke, and permanent paraplegia/paresis were 2% (n = 1), 0%, and 2% (n = 1), respectively. Median follow-up was 7.1 months (range, 1 to 38 months). Overall actuarial midterm survival was 63% at 38 months, with an aorta-specific actuarial survival of 94%. Two patients (4%) required late conversion to open repair. Postoperative type I or III endoleak occurred in 3 (6%) and type II endoleak in 7 (15%). Two patients underwent subsequent endovascular occlusion. The composite reintervention rate in follow-up was 23.4% (n = 13).

Conclusions: Endovascular repair for complicated acute and chronic type B dissection is safe and effective at early midterm follow-up. TEVAR for type B dissection requires more secondary interventions and imaging surveillance than conventional open reconstruction. Longer-term follow-up is needed to determine the durability of this approach.

This article has been cited by other articles:

				M. Di Eusanio, A. Armaro, L. Di Marco, D. Pacini, C. Savini, S. Martin Suarez, E. Pilato, and R. Di Bartolomeo Short- and midterm results after hybrid treatment of chronic aortic dissection with the frozen elephant trunk technique Eur J Cardiothorac Surg, October 1, 2011; 40(4): 875 - 880. [Abstract] [Full Text] [PDF]

				C. J. Parsa, J. B. Williams, S. D. Bhattacharya, W. G. Wolfe, M. A. Daneshmand, R. L. McCann, and G. C. Hughes Midterm results with thoracic endovascular aortic repair for chronic type B aortic dissection with associated aneurysm. J. Thorac. Cardiovasc. Surg., February 1, 2011; 141(2): 322 - 327. [Abstract] [Full Text] [PDF]

				M. Czerny, S. Roedler, S. Fakhimi, G. Sodeck, M. Funovics, J. Dumfarth, J. Holfeld, M. Schoder, A. Juraszek, T. Dziodzio, et al. Midterm Results of Thoracic Endovascular Aortic Repair in Patients With Aneurysms Involving the Descending Aorta Originating From Chronic Type B Dissections Ann. Thorac. Surg., July 1, 2010; 90(1): 90 - 94. [Abstract] [Full Text] [PDF]