Preferences help
enabled [disable] Abstract
Number of results
2012 | 84 | 1 | 23-30
Article title

Own Clinical Observations of Treatment Outcome in Acute Type B Aortic Dissection

Title variants
Languages of publication
The aim of the study was to analyse early results of treatment of acute type B aortic dissection.Material and methods. 59 patients, treated between 1998 and 2011, were divided into four groups. Group I comprised ten patients in whom hybrid procedures were performed: extra-anatomical by-pass graft from the brachio-cephalic trunk to the left carotid artery in six patients, transposition of the left carotid artery to the right one in two patients, and reversed Y prosthesis from the brachio-cephalic trunk to both carotids in the remaining 2 patients, to facilitate stent-grafting. Group II comprised 13 patientsin whom endovascular procedures were performed (stent-grafting). Group III comprised 21 patients in whom conventional surgery was done. Group IV comprised 15 patients who were treated conservatively.Results. In group I, a very good clinical outcome, without complications, was achieved in six patients (60% of cases). The total mortality rate was 40%. One patient died on the operation table, following stent-grafting, due to the rupture of the aortic arch. Two patients died as a result of brain damage (cerebral aneurysm rupture in one, and ischemic stroke in the other). In one patient, an aorto-oesophageal fistula developed. In group II, one patient died during endovascular procedure. Another patient suffered from type 1 endoleak, requiring repeated endovascular surgery. In group III, 15 patients (72%) died. Moreover, four patients required acorrective cardiac surgery (Bentall procedure)which in three patients resulted in death. Thus, the total mortality rate in this group was as high as 85%. In group IV, the mortality rate was 13%.Conclusions. We noticed a clear superiority of endovascular procedures over conventional surgeries-for acute type B aortic dissection. Hybrid procedures for acute, complicated type B aortic dissection evidently reduce mortality and postoperative morbidity. Uncomplicated acute type B aortic dissections should be treated conservatively at intensivecare units.
Physical description
1 - 1 - 2012
3 - 4 - 2012
  • Department of Surgery, 4 Military Clinical Hospital in Wrocław
  • Department of Vascular, General and Transplantological Surgery, Medical University in Wrocław
  • Department of General Radiology, Interventional Radiology and Neuroradiology, Medical University in Wrocław
  • Department of Surgery, 4 Military Clinical Hospital in Wrocław
  • Department of Surgery, 4 Military Clinical Hospital in Wrocław
  • Department of Surgery, 4 Military Clinical Hospital in Wrocław
  • Atkins MD jr, Blach JH, Cambria RP et al.: Aortic dissection: perspectives in the era of stent-graft repair. J Vasc Surg 2006; 43 (Suppl A): 30A-43A.[Crossref]
  • McDermont CD, Sermer M, Siu SC et al.: Aortic dissection complicating pregnancy following prophylactic aortic root replacement in woman with Marfan syndrome. Int J Cardiol 2006; 120: 427-30.[WoS]
  • Williams JA, Loeys BL, Nwakanma LU et al.: Early surgical experience with Loeys-Dietz now syndrome of aggressive thoracic aortic aneurysm disease. Ann Thorac Surg 2007; 83: S757-63.
  • Tsai TT, Evangelista A, Nienaber CA et al.: Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med 2007; 357: 349-59.[WoS]
  • Estera AL, Miller CC, Goodrick J et al.: Update on outcomes of acute type B aortic dissection. Ann Thorac Surg 2007; 83: 842-45.[WoS]
  • Winnerkvist A, Brorsson B, Radegran K et al.: Quality of life in patients with chronic type B aortic dissection. Eur J Vasc Endovasc Surg 2006; 32: 34-37.[Crossref][PubMed]
  • Winnerkvist A, Locowandt U, Rasmussen E et al.: A prospective study of medically treated acute type B aortic dissection. Eur J Vasc Endovasc Surg 2006; 32: 349-55.[Crossref][PubMed]
  • Nienaber CA, Rehders TC, Ince H et al.: Interventional strategies for treatment of aortic dissection. J Cardivasc Surg (Torino) 2006; 47: 487-96.[PubMed]
  • Schoder M, Czerny M, Cejna M et al.: Endovascular repair of acute type B aortic dissection:long-term follow-up of true and false lumen diameter chan ges. Ann Thorac Surg 2007; 83: 1059-66.
  • Tsai TT, Fattori R, Trimarchi S et al.: Long-term survival in patients presenting with type B acute aortic dissection:insights from the International Registry of acute Aortic Dissection. Circulation 2006; 114: 2226-31.
  • Song TK, Donayre CE, Walot I et al.: Endograft exclusion of acute and chronic descending thoracic aortic dissection. J Vasc Sur 2006; 43: 247-58.[Crossref]
  • Dialetto G, Covino FE, Scognamiglio G et al.: Treatment of type B aortic dissection: endoluminal repair or conventional medical therapy. Eur J Cardiothorac Surg 2005; 27: 826-30.[Crossref]
  • Eggebrecht H, Nienaber C, Neuhauser M et al.: Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J 2006; 27: 489-98.
  • Henke PK, Williams DM, Upchurch GR Jr et al.: Acute limb ischemia associated with type B aortic disscection: clinical relevance and therapy. Surgery 2006; 140: 532-39.
  • Coselli JS: Panel discussion:session III-natural history and dissection. Ann Thorac Surg 2007; 83: 846-50.[WoS]
  • Gaxotte V, Thony F, Rousseau H et al.: Midterm results of aortic diameter outcomes after thoracic stent-graft implantation for aortic dissection: a multicenter study. J Endovasc Ther 2006; 13: 127-38.[Crossref][PubMed]
  • Czerny M, Gottardi R, Zimpfer D et al.: Midterm results of supraaortic transpositions for extendend endovascular repair of aortic arch pathologies. Eur J Cardiothorac Surg 2007; 31: 623-27.[Crossref]
  • Chuter TA, Reilly LM et al.: Branched and fenestrated stent grafts for endovascular repair of thoracic aortic aneurysms. J Vasc Surg 2006; 43(suppl A): 111A-5A.
  • Czerny M, Zimpfer D, Rodler S et al.: Endovascular stent-graft placement of aneurysms involving the descending aorta originating from chronic type B dissections. J Thorac Surg 2007; 83: 1635-39.[WoS]
  • Bockler D, Schumacher H, Gantenm G et al.: Complications after endovascular repair of acute symptomatic and chronic expanding type Stanford B aortic dissection. J Thorac Cardivasc Surg 2006; 132: 361-68.
  • Krasoń M, Krupa H, Zembala M: Wewnątrznaczyniowe leczenie tętniaków aorty piersiowej w roku 2008 - u kogo, dlaczego, kiedy? Kardiologia Pol 2008; 66: 364-70.
  • Muhs BE, Balm R, White GH et al.: Anatomic factors associated with acute endograft collapse after Gore TAG treatment of thoracic aortic dissection or traumatic rupture. J Vasc Surg 2007; 45: 655-61.[Crossref]
  • Weigang E, Luehr M, Harloff A et al.: Incidence of neurological complications following overstenting of the left subclavian artery. Eur J Cardiothorac Surg 2007; 31: 628-36.[Crossref][WoS][PubMed]
  • Fanelli F, Salvatori FM, Marcelli G et al.: Type A aortic dissection developing during endovascular repair of an acute type B dissection. J Endovasc Ther 2003; 10: 254-59.[Crossref]
  • Bavaria JE, Appoo JJ, Makaroun MS et al.: Endovascular stent-grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patient: a multicenter comparative trial. J Thorac Cardivasc Surg 2007; 133: 369-77.
  • Motyka M, Grodowski M, Ruciński T et al.: Rozwarstwienie tętniaka piersiowo-brzusznego z towarzyszącymi obustronnymi tętniakami tętnic biodrowych wspólnych i wewnętrznych powikłane pęknięciem tętniaka lewej tętnicy biodrowej wewnętrznej - opis przypadku. Acta Angiol 2009; 15,3: 120-28.
  • Won JY, Suh SH, Ko HK et al.: Problems encountered during and after stent-graft treatment of aortic dissection. J Vasc Interv Radiol 2006; 17: 271-81.[Crossref]
  • Yamaguchi M, Sugimoto K, Tsuji Y et al.: Percutaneus balloon fenestration and stent placement for lower limb ischemia complicated with and aortic dissection. Radiat Med 2006; 24: 233-37.[Crossref]
  • Xu SD, Huang FJ, Yang JF et al.: Endovascular repair of acute type B aortic dissection: early and mid-term results. J Vasc Surg 2006; 43: 1090-95.[Crossref]
  • Eggebrecht H, Herold U, Kuhnt O et al.: Endovascular stent-graft treatment of aortic dissection: determinants of post-interventional out-come. Eur Heart J 2005; 26: 489-97.[Crossref]
  • Hatzaras I, Tranquilli M, Coady M et al.: Weigth lifting and aortic dissection: more evidence for a connection. Cardiolgy 2006; 107: 103-06.
  • Chiesa R, Melissano G, Marrocco-Trischitta MM et al.: Spinal cord ischaemia after elective stent-graft repair of the thoracic aorta. J Vasc Surg 2005; 42: 11-17.[Crossref]
  • Nienaber CA, Rousseau H, Eggebrecht H et al.: Randomized comparison of strategies for type B aortic dissection: the INvestigation of STEnt Graft In Aortic Dissection (INSTEAD) trial. Circulation 2009; 120(25): 2519-28.
  • Danyi P, Elefteriades JA, Jovin IS: Medical therapy of thoracic aortic aneurysms: are we there yet. Circulation 2011; 124(13): 1469-76.
Document Type
Publication order reference
YADDA identifier
JavaScript is turned off in your web browser. Turn it on to take full advantage of this site, then refresh the page.