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Eur J Vasc Endovasc Surg. 2012 Apr;43(4):386-91. doi: 10.1016/j.ejvs.2012.01.016. Epub 2012 Feb 9.

Predictors of outcome after endovascular repair for chronic type B dissection.

Author information

1
Department of Vascular Surgery, Guy's and St Thomas NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK. kevin.mani@surgsci.uu.se

Abstract

OBJECTIVES:

To assess the durability of endovascular repair (TEVAR) in chronic type B dissection (CD) and identify factors predictive of outcome.

DESIGN:

Retrospective analysis of a prospective database.

MATERIALS:

Patients undergoing TEVAR for CD at a tertiary referral centre 2000-2010.

METHODS:

Analysis of pre-operative characteristics, operative outcome, false lumen thrombosis, aortic diameter and survival.

RESULTS:

58 consecutive patients were included (49 elective, 9 urgent, mean age 66 years). Mean aortic diameter was 6.4 cm (Standard deviation SD 1.3 cm). Three patients died perioperatively (5%, 1 urgent, 2 elective). Complications included retrograde type A dissection (n = 3), paraplegia (1), and transient ischaemic attack (1). Estimated survival (Kaplan-Meier) was 89% (1-year) and 64% (3-years). Forty-seven patients had mid-term imaging follow-up at mean 38 months. Reintervention rate was 15% at 1-year and 29% at 3-years. Aortic diameter decreased in 24, was stable in 15 and increased in 8. Mid-term survival was higher in patients with aortic remodelling (reduction of aortic diameter >0.5 cm; 3-year 89%) than without (54%; Log Rank p = 0.005). Remodelling occurred with extensive false lumen thrombosis.

CONCLUSION:

Satisfactory mid-term outcome after TEVAR for CD remains a challenge. Survival is associated with aortic remodelling, which is related to persistence of flow in the false lumen.

PMID:
22326695
DOI:
10.1016/j.ejvs.2012.01.016
[Indexed for MEDLINE]
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