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

• Authors: Dariusz Janczak , Jan Skóra , Jerzy Garcarek , Andrzej Litarski , Marcim Merenda , Artur Wieraszko
• Languages of publication: EN

Abstracts

EN

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.

Keywords

EN

acute aortic dissection; hybrid procedures; stentgraft

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2012
• Volume: 84
• Issue: 1
• Pages: 23-30

Dates

published

1 - 1 - 2012

online

3 - 4 - 2012

Contributors

author

Dariusz Janczak

• Department of Surgery, 4 Military Clinical Hospital in Wrocław

author

Jan Skóra

• Department of Vascular, General and Transplantological Surgery, Medical University in Wrocław

author

Jerzy Garcarek

• Department of General Radiology, Interventional Radiology and Neuroradiology, Medical University in Wrocław

author

Andrzej Litarski

• Department of Surgery, 4 Military Clinical Hospital in Wrocław

author

Marcim Merenda

• Department of Surgery, 4 Military Clinical Hospital in Wrocław

author

Artur Wieraszko

• Department of Surgery, 4 Military Clinical Hospital in Wrocław

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Identifiers

DOI

10.2478/v10035-012-0004-5