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ludc webb

Nuno Dias

Associate professor

ludc webb

Malperfusions in Acute Type B Aortic Dissection—Predictors of Outcomes

Author

  • Jonathan Sobocinski
  • Matthieu Delloye
  • Kiattisak Hongku
  • Timothy Resch
  • Bjorn Sonesson
  • Stéphan Haulon
  • Nuno V. Dias

Summary, in English

Background: Acute type B aortic dissection (AoD) with malperfusion is a rare and complex disease. In this specific setting, invasive treatment is generally required to improve aortic branch vessel flow. Thoracic aorta stent grafting (TEVAR) of the proximal descending thoracic aorta to cover/exclude the proximal intimal entry tear would promote resolution of the dynamic component (the most prevalent) of the malperfusion conflict by redirecting the flow within the true lumen. The aim was to study outcomes of patients undergoing TEVAR for acute (<14 days) type B AoD complicated with malperfusion and to depict any preoperative and intraoperative predictors that could affect the prognosis of those patients. Methods: From March 2005 to January 2016, all patients treated with TEVAR for acute type B AoD with malperfusion in 2 European high-volume aortic centers were retrospectively studied. Preoperative, intraoperative, and postoperative details were collected. Preoperative computed tomography angiogram was reanalyzed on a dedicated 3D workstation (Aquarius iNtuition Viewer, TeraRecon). Thirty-day malperfusion-related complication and mortality rates were determined. Logistic regression model was used to assess preoperative and intraoperative factors affecting postoperative outcomes; in particular, details on the mechanisms of malperfusion and organ(s) involved were entered into the model and tested. Results: A total of 41 patients (60 years old [interquartile range (IQR): 51–68.5]; 78% men) have been included in the analysis. Patients were mostly (68.3%) affected by only 1 malperfusion syndrome, with renal ischemia being the most frequent (53.6%). The median length of aortic coverage was 197 mm (IQR: 157–209). Additional visceral/renal/iliac stentings were performed after stent graft implantation for 25 branches in 17 patients (41%). The 30-day mortality rate was 17.1%. All but 2 early deaths were related to malperfusion. The number of malperfusion syndromes was the only independent factor associated to increasing 30-day malperfusion-related complications or deaths (3 vs 1, HR = 30.3 [P = 0.001]; 3 vs 2, HR = 9.9 [P = 0.004]). Conclusions: Prognosis of patients with acute type B AoD complicated initially with malperfusion syndrome(s) is severe, especially if several territories are ischemic. Early identification of those complications can be lifesaving but still lacks hard criteria.

Department/s

  • Vascular Diseases - Clinical Research

Publishing year

2019-04-26

Language

English

Pages

119-126

Publication/Series

Annals of Vascular Surgery

Volume

59

Document type

Journal article

Publisher

Springer

Topic

  • Surgery

Status

Published

Research group

  • Vascular Diseases - Clinical Research

ISBN/ISSN/Other

  • ISSN: 0890-5096