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Ann Vasc Surg. 2018 May;49:107-114. doi: 10.1016/j.avsg.2017.11.054. Epub 2018 Feb 23.

Surgical Treatment of Synchronous Type B Acute Aortic Dissection and Abdominal Aortic Aneurysm.

Author information

1
Vascular Surgery, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy.
2
Cardiac Surgery, Sacco Hospital, University of Milan School of Medicine, Milan, Italy.
3
Vascular Surgery 2, Thoracic Aortic Research Center, IRCCS Policlinico San Donato Teaching Hospital, University of Milan School of Medicine, San Donato Milanese, Italy.
4
Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine and ASST Settelaghi University Hospital, Varese, Italy.
5
Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine and ASST Settelaghi University Hospital, Varese, Italy. Electronic address: gabriele.piffaretti@uninsubria.it.

Abstract

BACKGROUND:

We report the results of the operative treatment of synchronous type B acute aortic dissection (TBAAD) and infrarenal abdominal aortic aneurysm (AAA).

METHODS:

It is an observational, descriptive multicenter case series. Inclusion criterion was patients with diagnosis of TBAAD and AAA detected synchronously for the first time at clinical onset of dissection. Follow-up imaging protocol included triple-phase spiral/computed tomography angiography performed at 1, 6, and 12 months after thoracic endovascular aortic repair (TEVAR), and annually thereafter. Major end points were perioperative mortality and long-term survival, freedom from aortic events, and freedom from reintervention.

RESULTS:

We identified and treated 15 cases. All TBAADs were treated by TEVAR in the acute phase: infrarenal aortic repair was performed with stent graft (SG) in 10 (66.7%) patients, with open repair in 5 (33.3%). Overall, staged repair was used in 11 (73.3%) patients. Mean descending aortic endovascular length coverage was 21 cm ± 7 (range, 10-35; interquartile range [IQR], 150-265). Overall, early perioperative mortality occurred in 1 (6.7%) patient. Median radiologic follow-up was 48 months (range, 6-120; IQR, 36-67). During the follow-up, TEVAR-related mortality was not observed. Aortic remodeling after TEVAR was obtained in 12 (85.7%) patients; abdominal sac shrinkage after SG was obtained in 8 (80.0%) patients. Freedom from aortic event rate was 79% ± 10 (95% confidence interval [CI]: 53.1-92.6) at 1 year and 64% ± 13 (95% CI: 38.1-83.5) at 5 year. Freedom from reintervention rate at 1 and 5 year was 85% ± 10 (95% CI: 57.8-95.7).

CONCLUSIONS:

In our experience, the association of TBAAD and AAA was a rare finding. Because of the lack of available evidence to opt for a single intervention or a staged approach, selective approach with TEVAR and endovascular/open conventional treatment of the abdominal aorta yielded satisfactory results at midterm follow-up.

PMID:
29481924
DOI:
10.1016/j.avsg.2017.11.054
[Indexed for MEDLINE]

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