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Treating Aortic Dissection: Success and Failures in the Endovascular Era
Kyla R. Shelton, M.D., Ahsan T. Ali, MD, Mohammad M. Moursi, M.D., J Gregory Modrall, M.D., John F. Eidt, M.D..
University of Arkansas for Medical Sciences, Little Rock, AR, USA.

OBJECTIVES: Aortic dissection (AD) can be a catastrophic emergency. Stanford Type-A dissections are usually treated urgently. Indications for intervention Type-B were: end organ ischemia, rupture or lumen expansion. The objective of this study was to look at outcomes for AD in a contemporary vascular academic center.
METHODS: All patients with AD were included over an 11 year period from 2000-2011. Patients were divided into Stanford Type A or B
RESULTS: Over an 11-year period, 98 patents presented with the diagnosis of AD. There were 34 Type-A and 64 Type-B. Out of 34, Type-A, thirty underwent urgent repair. Perioperative mortality was 56% and 12-month mortality was 64%.
For Type-B; 53 were acute and 11 were chronic or >2 weeks after the initial diagnosis. The mean age was 58.6 ±16 where 45 (70%) were men. Total of 49 procedures were performed. Indications for surgery were refractory hypertension in 15%, limb ischemia in 13.3% visceral ischemia 24%, progression of dissection in 4.4%, rupture in 9% and enlargement in 29%. The time to surgical intervention was 2.1(0-185) days. Two patients died from rupture before surgery. Procedure related or in-hospital mortality was 20% while 12-month mortality for the Type-B was 33%. Of the patients that survived 12-month, 37% were lost to follow up. Open repair was performed in 3 patients where two died during surgery. Most common procedure was a thoracic endograft 80% with covering of subclavian artery in all. Two patients had lower extremity ischemia and underwent a femorofemoral bypass. Six visceral revascularization were done with stents.
CONCLUSIONS: There is a clear advantage of endovascular approach in Type-B. However, AD remains a morbid disease with high mortality. Furthermore, a significant number of patients were lost to follow up. A new approach may be needed to address this issue.


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