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Distinction between Acute and Chronic Type B Aortic Dissection: Is there a sub-acute phase?


Steuer, J; Björck, M; Mayer, D; Wanhainen, A; Pfammatter, T; Lachat, M (2013). Distinction between Acute and Chronic Type B Aortic Dissection: Is there a sub-acute phase? European Journal of Vascular and Endovascular Surgery, 45(6):627-631.

Abstract

OBJECTIVES: This study aims to assess the relevance of the definition of acute dissection, to analyse whether there is a sub-acute phase and to determine early outcome of thoracic endovascular aortic repair (TEVAR) in acute complicated type B aortic dissection. DESIGN: Dual-centre consecutive case series. MATERIALS: Between 1999 and 2011, 102 patients underwent TEVAR for non-traumatic acute complicated type B dissection in Zurich, Switzerland, and Uppsala, Sweden. In addition, 22 patients treated for an acute dissection-related complication occurring >14 days after onset of symptoms were included. Median age was 68 years, 35% were women. METHODS: Demographic, procedural and outcome data were collected prospectively. The patients were followed up on 1 January 2012. RESULTS: In the 22 sub-acute patients (18%), there were no early deaths or neurological complications. The predominant complication in these patients was rapid aortic enlargement, whereas rupture was more prevalent in patients treated within 14 days. In total, there were nine (7%) early deaths, three (2%) post-intervention paraplegias and six cases of stroke (5%). CONCLUSIONS: TEVAR was performed with low early mortality and few neurological complications. A significant proportion of patients presented with acute complications >14 days after onset of symptoms, indicative of a sub-acute phase in the transition between acute and chronic dissection, questioning the relevance of the current definition.

Abstract

OBJECTIVES: This study aims to assess the relevance of the definition of acute dissection, to analyse whether there is a sub-acute phase and to determine early outcome of thoracic endovascular aortic repair (TEVAR) in acute complicated type B aortic dissection. DESIGN: Dual-centre consecutive case series. MATERIALS: Between 1999 and 2011, 102 patients underwent TEVAR for non-traumatic acute complicated type B dissection in Zurich, Switzerland, and Uppsala, Sweden. In addition, 22 patients treated for an acute dissection-related complication occurring >14 days after onset of symptoms were included. Median age was 68 years, 35% were women. METHODS: Demographic, procedural and outcome data were collected prospectively. The patients were followed up on 1 January 2012. RESULTS: In the 22 sub-acute patients (18%), there were no early deaths or neurological complications. The predominant complication in these patients was rapid aortic enlargement, whereas rupture was more prevalent in patients treated within 14 days. In total, there were nine (7%) early deaths, three (2%) post-intervention paraplegias and six cases of stroke (5%). CONCLUSIONS: TEVAR was performed with low early mortality and few neurological complications. A significant proportion of patients presented with acute complications >14 days after onset of symptoms, indicative of a sub-acute phase in the transition between acute and chronic dissection, questioning the relevance of the current definition.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:14 May 2013 07:54
Last Modified:05 Apr 2016 16:47
Publisher:Elsevier
ISSN:1078-5884
Publisher DOI:https://doi.org/10.1016/j.ejvs.2013.03.013
PubMed ID:23602854

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