Elsevier

The Annals of Thoracic Surgery

Volume 86, Issue 5, November 2008, Pages 1707-1712
The Annals of Thoracic Surgery

Review
Outcome of Endovascular Treatment of Acute Type B Aortic Dissection

https://doi.org/10.1016/j.athoracsur.2008.06.074Get rights and content

Complicated type B aortic dissection is a life-threatening condition. For the last decade, endovascular stent-graft placement has been increasingly used to treat this condition. We undertook a summary analysis of published studies reporting the outcome of stent-grafts to treat complicated type B dissection. Studies were identified from a literature search using the MEDLINE database, and included studies when 10 or more patients were reported and at least in-hospital mortality was presented. A total of 942 patients were included from 29 studies. All patients were reported to have complications requiring intervention (hypotension in 17%). In-hospital mortality was 9% and other major complications (ie, stroke, paraplegia, conversion to type A dissection, bowel infarction, major amputation) occurred in 8.1%. Long-term follow-up was limited to a mean of 20 months. During this time, reintervention was required in 10.4% and aortic rupture was reported in 0.8%. Endovascular treatment of complicated acute type B aortic dissection seems to provide favorable initial outcomes and would seem to be a great addition to the treatment options for this condition. Further study of long-term outcomes is required.

Section snippets

Study Selection

Using the keywords “acute,” “aortic,” “dissection,” “aortic syndrome,” and “endovascular,” a comprehensive search was conducted using the MEDLINE database. We also searched reference lists of identified publications. We sought studies in which patients with acute type B aortic dissection were treated by endovascular stent-grafts. To keep findings contemporary; we only included studies published between 1997 and 2007. There were 148 identified articles; and the abstracts were initially reviewed.

Preoperative Patient Characteristics

From the total of 148 studies, 29 met the inclusion criteria and were selected for data extraction [5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33]. Three of these studies included more than 100 patients each and contributed 40% of the total of 942 patients [18, 28, 31]. The presenting characteristics of the patients are illustrated in Table 1. The mean age was relatively young at 61 years and the majority of patients were male with

Comment

We believe that this is the first study that summarizes the current outcomes of endovascular stent-graft treatment particularly focusing on patients with acute type B aortic dissection. Two previous reviews have reported the combined results of both acute and chronic type B dissection, and in one of these studies a sub-analysis was presented on patients with acute dissection [3, 4]. Compared with these reports, we focused on acute dissection alone, included only articles with larger number of

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    Copyright © 2008 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.