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Vascular. 2018 Aug;26(4):418-424. doi: 10.1177/1708538117749406. Epub 2018 Jan 8.

Endovascular treatment of acute and chronic isolated abdominal aortic dissection.

Wang D1,2, Ma T1,2, Guo D1,2, Xu X1,2, Chen B1,2, Jiang J1,2, Yang J1,2, Shi Z1,2, Zhu T1,2, Shi Y1,2, Dong Z1,2, Fu W1,2.

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1 Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
2 Institute of Vascular Surgery, Fudan University, Shanghai, China.


Objective To discuss the strategies and clinical outcomes of endovascular aortic repair (EVAR) for acute and chronic isolated abdominal aortic dissection (IAAD). Methods From January 2012 to June 2017, 33 patients with IAAD were retrospectively reviewed. Patients were classified into acute and chronic groups based on the time to EVAR from IAAD onset (acute: ≤90 days; chronic: >90 days). Patient demographics, clinical parameters, procedural factors, and clinical outcomes were evaluated and compared between the two groups. Results Among 33 patients, 21 were diagnosed with acute IAAD and 12 were diagnosed with chronic IAAD. All patients underwent EVAR, and no significant difference in EVAR-related procedural factors was observed between the two groups. The primary technical success rate in all patients was 100%. The overall survival rate in the chronic group was lower than that in the acute group, but the difference was not statistically significant ( P = 0.186). However, the reintervention-free survival rate in the chronic group was significantly lower than that in the acute group ( P = 0.039). Significant enlargement of the true lumen (TL) and regression of the false lumen (FL) and maximal aortic diameter were observed in all patients after EVAR ( P < 0.05). The mean diameter of the TL in the acute group increased significantly more than that in the chronic group (14 ± 3 mm vs. 11 ± 3 mm, P = 0.040). A significant difference was not observed in the regression of the FL ( P = 0.628) or maximal aortic diameter ( P = 0.319) between the two groups. Conclusion EVAR continues to be a safe therapeutic approach with a high technical success rate and favorable clinical outcomes. The clinical outcomes and aortic remodeling in the chronic group seem to be poorer than those in the acute group.


Isolated abdominal aortic dissection; acute or chronic stages; aortic remodeling; clinical outcome; endovascular aortic repair; intervention strategy

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