%0 Journal Article
%T Medium-Term Results of Treatment for Complicated Acute Type B Dissection: A Spanish Experience in a Single Centre
%A Jesus Alvarez-Garcia
%A Stefan Stefanov Kiuri
%A Alvaro Fernandez Heredero
%A Andres Salazar Alvarez
%A Nieves Aleicel Concepcion Rodriguez
%A Luis Riera de Cubas
%J Journal of Angiology
%D 2014
%R 10.1155/2014/572019
%X Objective. To analyze and evaluate medium-term results obtained in endovascular treatment of complicated type B dissection. Methods. Prospective registry and retrospective analysis of the dissections treated with endoprosthesis in 1998 and 2010. Comorbidity, clinical presentation, anatomical characteristics, and evolution were recorded. Actuarial analysis was conducted for survival, follow-up and survival free of endoleaks, and free of reintervention due to relapse and/or progression. Results. Eighteen (18) patients were treated (14 male : 4 female), with a median age of 53 years (range 29每80). Their main symptoms were acute pain in 16 cases and hypertensive crisis in 15. The indications were 10 dissections not controlled by medication, 4 aneurysm dissecans, 2 acute lower limb ischemias, and 2 Type A progressions. Median 1.7 devices were used (range 1每4). Coverage of left subclavian artery was required in 3 cases, and of subclavian and left carotid artery in other 2 cases. There was a 100% technical success. Median follow-up was 43.1 months (1.5每127 range). There were two deaths caused by multiorganic failure, early mortality of 0%, and hospital mortality of 11%. There was a case of Type I Endoleak and 5 cases which required a new intervention due to relapse and/or progression. Cumulative survival at 30 months was 88%; follow-up free of endoleaks at 36 months was 91%. Follow-up free of progression/relapse at 12 months was 88%. Conclusion. Endovascular treatment of complicated type B acute dissection is an effective therapy for this condition, with a low associated mortality and with acceptable survival. 1. Introduction Acute type B aortic dissection (B-AD) is still a life threatening situation [1每3], particularly complicated ones, which comprise up to 22% [3每5]. Dissection is considered complicated when present at least one of the following features: refractoriness to medical treatment, in terms of blood pressure and/or pain management, ascending progression, malperfusion syndromes, and/or aneurysmal degeneration with a diameter of 5.5 centimeters or more [1, 6, 7]. Besides these characteristics described about dissection, the fragility of these patients explains their high mortality. They are typically elderly with high comorbidity and/or connective tissue diseases [1, 7]. Regarding treatments to be used, medical treatment is the best choice in noncomplicated dissections [1, 6, 7], while in complicated dissection presents mortality rates of 20% on the second day and between 25 and 50% in month [4, 7], which inevitably leads to consider the use of more
%U http://www.hindawi.com/journals/jangi/2014/572019/