TYPE B AORTIC DISSECTION - A SINGLE CENTER SERIES

Authors

  • Isabel Poleri Faculty of Medicine, University of Porto, Portugal
  • Marina Dias-Neto Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, São João Hospital, Porto, Portugal
  • João Rocha-Neves Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, São João Hospital, Porto, Portugal; Department of Biomedicine – Unity of Anatomy, Faculdade de Medicina da Universidade do Porto, Portugal

DOI:

https://doi.org/10.48729/pjctvs.127

Abstract

Background: Type B aortic dissection (TBAD) is associated with high morbidity and mortality. The DISSECT classification aims to reunite clinical and anatomical characteristics of interest to clinicians involved in its management. This paper aims to characterize a cohort of patients admitted for type B aortic dissection in a tertiary institution.

Methods: This is a retrospective study that included all patients admitted to the hospital due to TBAD from 2006 to 2016. The computerized tomographic angiography that enabled the TBAD diagnosis were reevaluated using DISSECT classification.

Results: Thirty-two patients were included in this case series. As to DISSECT classification, 79.3% were acute (Duration), 66% had a primary Intimal tear location in aortic arch, the maximum aortic diameter was 44±13mm (Size), 60% extended from aortic arch to abdomen or iliac arteries (Segmental Extent), 28% presented with Complications, and 28% had partial Thrombosis of false lumen. Six patients underwent intervention during the follow-up period. At 12 months, overall survival was 75.4%±8.3% and survival free of aorta-related mortality was 87.0±6.1%. Survival free of aortic dilatation was 82.6±9.5%. In univariate analysis, the presence of complications and chronic kidney disease associated with increased overall and aorta-related mortality rates. Hypertension was associated with aortic dilatation.

Conclusions: The outcomes after TBAD in a Portuguese center are reported. All interventions in TBAD were performed due to complications. The presence of complications and chronic kidney disease was associated with overall mortality and aorta-related mortality and hypertension with aortic dilatation. DISSECT classification was possible to apply in all patients.

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References

Tang DG, Dake MD. TEVAR for acute uncomplicated aortic dissection: immediate repair versus medical therapy. Semin Vasc Surg 2009;22:145-51.

Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg 1970;10:237-47.

Scott AJ, Bicknell CD. Contemporary Management of Acute Type B Dissection. Eur J Vasc Endovasc Surg 2016;51:452-9.

Jonker FH, Trimarchi S, Muhs BE, et al. The role of age in complicated acute type B aortic dissection. Ann Thorac Surg 2013;96:2129-34.

Hughes GC, Andersen ND, McCann RL. Management of acute type B aortic dissection. J Thorac Cardiovasc Surg 2013;145:S202-7.

Suzuki T, Mehta RH, Ince H, et al. Clinical profiles and outcomes of acute type B aortic dissection in the current era: lessons from the International Registry of Aortic Dissection (IRAD). Circulation 2003;108 Suppl 1:II312-7.

Cruz Tomas A, Laranjeira Santos A, Pinheiro Santos J, Varela-Afonso D, Fragata J. TEVAR - A Primary or Adjunct Procedure Helpful in the Surgical Correction of Complex Pathology of the Thoracic Aorta? Rev Port Cir Cardiotorac Vasc 2017;24:128.

Dias-Neto M, Ramos JF, Dias PG, et al. [TEVAR: a strategy for the diversity of thoracic aorta disease. Series of cases and national prospect]. Rev Port Cir Cardiotorac Vasc 2014;21:43-54.

Riambau V, Bockler D, Brunkwall J, et al. Editor's Choice - Management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2017;53:4-52.

Nienaber CA, Rousseau H, Eggebrecht H, et al. Randomized comparison of strategies for type B aortic dissection: the INvestigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial. Circulation 2009;120:2519-28.

Nienaber CA, Kische S, Rousseau H, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv 2013;6:407-16.

Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014;35:2873-926.

Nienaber CA, Divchev D, Palisch H, Clough RE, Richartz B. Early and late management of type B aortic dissection. Heart 2014;100:1491-7.

Brunkwall J, Kasprzak P, Verhoeven E, et al. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg 2014;48:285-91.

Dake MD, Thompson M, van Sambeek M, Vermassen F, Morales JP, Investigators D. DISSECT: a new mnemonic-based approach to the categorization of aortic dissection. Eur J Vasc Endovasc Surg 2013;46:175-90.

Czerny M, Schmidli J, Bertoglio L, et al. Clinical Cases Referring to Diagnosis and Management of Patients With Thoracic Aortic Pathologies Involving the Aortic Arch: A Companion Document of the 2018 European Association for Cardio-Thoracic Surgery (EACTS) and the European Society for Vascular Surgery (ESVS) Expert Consensus Document Addressing Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch. Eur J Vasc Endovasc Surg 2019;57:452-60.

Glower DD, Speier RH, White WD, Smith LR, Rankin JS, Wolfe WG. Management and long-term outcome of aortic dissection. Ann Surg 1991;214:31-41.

Umaña JP, Lai DT, Mitchell RS, et al. Is medical therapy still the optimal treatment strategy for patients with acute type B aortic dissections? The Journal of Thoracic and Cardiovascular Surgery 2002;124:896-910.

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.

Ray HM, Durham CA, Ocazionez D, et al. Predictors of intervention and mortality in patients with uncomplicated acute type B aortic dissection. J Vasc Surg 2016;64:1560-8.

Matsushita A, Hattori T, Tsunoda Y, Sato Y, Mihara W. Impact of initial aortic diameter and false-lumen area ratio on Type B aortic dissection prognosis. Interact Cardiovasc Thorac Surg 2017.

Guo B, Hou K, Guo D, et al. Outcomes of thoracic endovascular repair for type B aortic dissection with multichanneled

morphology. J Vasc Surg 2017;66:1007-17.

Schwartz SI, Durham C, Clouse WD, et al. Predictors of late aortic intervention in patients with medically treated type B aortic dissection. J Vasc Surg 2017.

Sailer AM, van Kuijk SM, Nelemans PJ, et al. Computed Tomography Imaging Features in Acute Uncomplicated Stanford Type-B Aortic Dissection Predict Late Adverse Events. Circ Cardiovasc Imaging 2017;10.

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Published

26-05-2021

How to Cite

1.
Poleri I, Dias-Neto M, Rocha-Neves J. TYPE B AORTIC DISSECTION - A SINGLE CENTER SERIES. Rev Port Cir Cardiotorac Vasc [Internet]. 2021 May 26 [cited 2024 Dec. 21];26(2):131-7. Available from: https://pjctvs.com/index.php/journal/article/view/127

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