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At least 1,351 records · Page 75Linked to original sources
PubMed2002

Surgical outcome of acute type A aortic dissection: analysis of risk factors.

BACKGROUND: The aim of this study was to assess the risk factors for the early and late outcome of the surgical treatment of acute type A aortic dissection. METHODS: From 1983 to 2000, a total of 130 patients underwent operation for acute type A aortic dissection. Extent of distal aortic resection included ascending aorta in 19 patients (15%), hemiarch in 29 (22%), and total arch in 82 (63%). In all, 31 preoperative and perioperative variables were analyzed using univariate and multiple logistic regression models for independent predictors of in-hospital mortality and risk of late reoperation. After excluding in-hospital deaths, risk factors for late death were analyzed by Cox proportional hazard analysis. RESULTS: In-hospital mortality was 19.2% (25 of 130 patients). Multivariable analysis indicated that renal/mesenteric ischemia and shock were independent predictors of in-hospital death. At 10 years, the actuarial survival rate including in-hospital mortality was 70.9% +/- 4.7%, and the reoperation event-free rate was 73.5% +/- 5.7%. Aortic valve resuspension was an independent predictor of proximal aortic reoperation, whereas nonresection of intimal tear and younger age were independent predictors for distal aortic reoperation. Chronic obstructive pulmonary disease was the only independent predictor for late death. CONCLUSIONS: Patients' preoperative dissection-related complications and comorbidities significantly affect early and late survival rates after surgical treatment of acute type A aortic dissection.

Acute Disease↗
PubMed2003

Percutaneous management of ischemic complications in patients with type-B aortic dissection.

PURPOSE: To review our experience with the use of percutaneous methods to manage the ischemic complications of type-B aortic dissection. MATERIALS AND METHODS: Retrospective review of our interventional radiology database identified 11 patients with acute type-B aortic dissection who underwent 13 endovascular procedures to attempt revascularization of 23 ischemic vascular territories (four mesenteric, 11 renal, eight lower extremities). Percutaneous interventions included balloon fenestration (four patients), aortic true lumen stent placement (three patients), and branch vessel stent placement (eight patients). RESULTS: Successful initial reperfusion of 21 of 23 vascular territories (91%) was achieved with use of percutaneous methods alone, with no 30-day mortality, in-hospital mortality, or paraplegia. One additional patient underwent successful initial treatment with use of a combined interventional/surgical approach to reperfuse an ischemic limb. One patient developed acute thrombosis of a dissected renal artery during stent placement. Increased aortic true lumen collapse later resulted in further ischemia in two patients. During follow-up (mean, 16 mo), no patient has had evidence of false lumen enlargement or late recurrent ischemia. CONCLUSION: Endovascular methods offer a less-morbid nonsurgical treatment alternative for patients with acute complicated type-B aortic dissection.

Aortic Dissection↗
PubMed1989

[Fate of the false lumen after surgery and assessment of operative procedure for DeBakey IIIb dissecting aortic aneurysm].

Eighteen patients with DAA IIIb were divided into two groups. Seven patients with major abdominal arteries originated from true lumen (group I) and 11 ones with renal artery or arteries from false lumen (group II). group I: In early postoperative phase (25-55 days), the descending aortic false lumen had been thrombo-occluded in all patients and the upper abdominal aortic false lumen had been still enhanced in three. In late postoperative phase (9-35 mos.), false lumen had been disappeared in three patients, so those aortae appeared normal morphologically and in other three patients thrombo-occluded false lumen reduced in size. group II: There were re-entries and the false originated renal arteries were well perfused in all patients. In nine patients with no leakage at anastomotic site, these descending aortic false lumens were thrombo-occluded. But as in the upper abdominal aortic false lumens, there was still enough blood flow to perfuse the false originated renal arteries. These suggest that the complete entry closure is the most important, so we recommend to graft the descending aorta containing entry with prosthesis, and this operation leads false lumen to 1) thrombo-occlusion, 2) absorption of thrombus and finally 3) normalization of injured aorta morphologically.

Adult↗
PubMedDate not supplied

A rare case of renovascular hypertension due to iatrogenic thoracoabdominal aortic dissection. A report of successful surgical treatment in childhood.

Renovascular hypertension due to iatrogenic thoracoabdominal aortic dissection in an 8-year-old girl with aortic valvular stenosis is presented. A splenorenal arterial anastomosis without splenectomy was successfully performed. This procedure is considered best suited for children with thoracoabdominal aortic dissection as the autogenous graft is expected to grow and provide long-term patency. The spleen left in situ was expected to be advantageous, from the immunological aspect, at the time of open heart surgery for aortic valvular stenosis, which was anticipated in the near future in this child.

Aortic Dissection↗