Outcome of medical and surgical treatment in patients with acute type B aortic dissection

Ron Bin Hsu, Yi Lwun Ho, Robert J. Chen, Shoei Shen Wang, Fang Yue Lin, Shu Hsun Chu

研究成果: 雜誌貢獻文章

37 引文 (Scopus)

摘要

Background. Optimal treatment of acute type B aortic dissection remain unclear. The aim of this study was to assess the clinical outcome of acute type B aortic dissection. Methods. In the last 8 years, 107 patients were admitted for acute type B aortic dissection. We medically treated patients at the time of onset with antihypertensives. Surgery was considered if there is intractable pain, uncontrolled hypertension, severe aortic branch malperfusion, or aneurysm expansion. Results. Twenty-nine patients had pleural effusion (27%), 9 patients had leg ischemia (8%), 5 patients had impending rupture, and 2 patients had aneurysm enlargement exceeding 60 mm on repeated imaging studies. A total of 16 patients (15%) underwent surgical intervention: 8 extra-anatomical bypass for leg ischemia, 1 in situ infrarenal aortoiliac bypass for distal aortic obstruction, and 7 thoracic aortic graft replacement. Of the 8 patients with extra-anatomic bypass, 3 patients died: 2 patients died of catastrophic aortic rupture 2 and 9 days after bypass, and 1 patient died of dissection progression to type A lesion 9 days after bypass. There was no in-hospital death in 92 medically treated patients. Follow-up was 92% complete. The mean follow-up duration was 36.1 months (range, 2 to 96 months). The 6-month, 1-year, and 5-year survival rates of all patients were 96.2 ± 1.9%, 95.2% ± 2.1%, and 95.2% ± 2.1%. Conclusions. Medical treatment of acute type B aortic dissection produced good outcomes. Central aortic procedures such as aortic fenestration and endovascular stenting should be the preferred methods to treat patients with acute type B aortic dissection and leg ischemia because there was high risk of central aortic complications after extra-anatomic bypass.
原文英語
頁(從 - 到)790-794
頁數5
期刊Annals of Thoracic Surgery
79
發行號3
DOIs
出版狀態已發佈 - 一月 1 2005
對外發佈Yes

指紋

Dissection
Therapeutics
Leg
Ischemia
Aneurysm
Intractable Pain
Aortic Rupture
Pleural Effusion
Antihypertensive Agents
Rupture
Thorax
Survival Rate
Hypertension
Transplants

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

引用此文

Outcome of medical and surgical treatment in patients with acute type B aortic dissection. / Hsu, Ron Bin; Ho, Yi Lwun; Chen, Robert J.; Wang, Shoei Shen; Lin, Fang Yue; Chu, Shu Hsun.

於: Annals of Thoracic Surgery, 卷 79, 編號 3, 01.01.2005, p. 790-794.

研究成果: 雜誌貢獻文章

Hsu, Ron Bin ; Ho, Yi Lwun ; Chen, Robert J. ; Wang, Shoei Shen ; Lin, Fang Yue ; Chu, Shu Hsun. / Outcome of medical and surgical treatment in patients with acute type B aortic dissection. 於: Annals of Thoracic Surgery. 2005 ; 卷 79, 編號 3. 頁 790-794.
@article{b86ff51aeace4884994e88f90b053577,
title = "Outcome of medical and surgical treatment in patients with acute type B aortic dissection",
abstract = "Background. Optimal treatment of acute type B aortic dissection remain unclear. The aim of this study was to assess the clinical outcome of acute type B aortic dissection. Methods. In the last 8 years, 107 patients were admitted for acute type B aortic dissection. We medically treated patients at the time of onset with antihypertensives. Surgery was considered if there is intractable pain, uncontrolled hypertension, severe aortic branch malperfusion, or aneurysm expansion. Results. Twenty-nine patients had pleural effusion (27{\%}), 9 patients had leg ischemia (8{\%}), 5 patients had impending rupture, and 2 patients had aneurysm enlargement exceeding 60 mm on repeated imaging studies. A total of 16 patients (15{\%}) underwent surgical intervention: 8 extra-anatomical bypass for leg ischemia, 1 in situ infrarenal aortoiliac bypass for distal aortic obstruction, and 7 thoracic aortic graft replacement. Of the 8 patients with extra-anatomic bypass, 3 patients died: 2 patients died of catastrophic aortic rupture 2 and 9 days after bypass, and 1 patient died of dissection progression to type A lesion 9 days after bypass. There was no in-hospital death in 92 medically treated patients. Follow-up was 92{\%} complete. The mean follow-up duration was 36.1 months (range, 2 to 96 months). The 6-month, 1-year, and 5-year survival rates of all patients were 96.2 ± 1.9{\%}, 95.2{\%} ± 2.1{\%}, and 95.2{\%} ± 2.1{\%}. Conclusions. Medical treatment of acute type B aortic dissection produced good outcomes. Central aortic procedures such as aortic fenestration and endovascular stenting should be the preferred methods to treat patients with acute type B aortic dissection and leg ischemia because there was high risk of central aortic complications after extra-anatomic bypass.",
author = "Hsu, {Ron Bin} and Ho, {Yi Lwun} and Chen, {Robert J.} and Wang, {Shoei Shen} and Lin, {Fang Yue} and Chu, {Shu Hsun}",
year = "2005",
month = "1",
day = "1",
doi = "10.1016/j.athoracsur.2004.07.061",
language = "English",
volume = "79",
pages = "790--794",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "3",

}

TY - JOUR

T1 - Outcome of medical and surgical treatment in patients with acute type B aortic dissection

AU - Hsu, Ron Bin

AU - Ho, Yi Lwun

AU - Chen, Robert J.

AU - Wang, Shoei Shen

AU - Lin, Fang Yue

AU - Chu, Shu Hsun

PY - 2005/1/1

Y1 - 2005/1/1

N2 - Background. Optimal treatment of acute type B aortic dissection remain unclear. The aim of this study was to assess the clinical outcome of acute type B aortic dissection. Methods. In the last 8 years, 107 patients were admitted for acute type B aortic dissection. We medically treated patients at the time of onset with antihypertensives. Surgery was considered if there is intractable pain, uncontrolled hypertension, severe aortic branch malperfusion, or aneurysm expansion. Results. Twenty-nine patients had pleural effusion (27%), 9 patients had leg ischemia (8%), 5 patients had impending rupture, and 2 patients had aneurysm enlargement exceeding 60 mm on repeated imaging studies. A total of 16 patients (15%) underwent surgical intervention: 8 extra-anatomical bypass for leg ischemia, 1 in situ infrarenal aortoiliac bypass for distal aortic obstruction, and 7 thoracic aortic graft replacement. Of the 8 patients with extra-anatomic bypass, 3 patients died: 2 patients died of catastrophic aortic rupture 2 and 9 days after bypass, and 1 patient died of dissection progression to type A lesion 9 days after bypass. There was no in-hospital death in 92 medically treated patients. Follow-up was 92% complete. The mean follow-up duration was 36.1 months (range, 2 to 96 months). The 6-month, 1-year, and 5-year survival rates of all patients were 96.2 ± 1.9%, 95.2% ± 2.1%, and 95.2% ± 2.1%. Conclusions. Medical treatment of acute type B aortic dissection produced good outcomes. Central aortic procedures such as aortic fenestration and endovascular stenting should be the preferred methods to treat patients with acute type B aortic dissection and leg ischemia because there was high risk of central aortic complications after extra-anatomic bypass.

AB - Background. Optimal treatment of acute type B aortic dissection remain unclear. The aim of this study was to assess the clinical outcome of acute type B aortic dissection. Methods. In the last 8 years, 107 patients were admitted for acute type B aortic dissection. We medically treated patients at the time of onset with antihypertensives. Surgery was considered if there is intractable pain, uncontrolled hypertension, severe aortic branch malperfusion, or aneurysm expansion. Results. Twenty-nine patients had pleural effusion (27%), 9 patients had leg ischemia (8%), 5 patients had impending rupture, and 2 patients had aneurysm enlargement exceeding 60 mm on repeated imaging studies. A total of 16 patients (15%) underwent surgical intervention: 8 extra-anatomical bypass for leg ischemia, 1 in situ infrarenal aortoiliac bypass for distal aortic obstruction, and 7 thoracic aortic graft replacement. Of the 8 patients with extra-anatomic bypass, 3 patients died: 2 patients died of catastrophic aortic rupture 2 and 9 days after bypass, and 1 patient died of dissection progression to type A lesion 9 days after bypass. There was no in-hospital death in 92 medically treated patients. Follow-up was 92% complete. The mean follow-up duration was 36.1 months (range, 2 to 96 months). The 6-month, 1-year, and 5-year survival rates of all patients were 96.2 ± 1.9%, 95.2% ± 2.1%, and 95.2% ± 2.1%. Conclusions. Medical treatment of acute type B aortic dissection produced good outcomes. Central aortic procedures such as aortic fenestration and endovascular stenting should be the preferred methods to treat patients with acute type B aortic dissection and leg ischemia because there was high risk of central aortic complications after extra-anatomic bypass.

UR - http://www.scopus.com/inward/record.url?scp=14244261343&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=14244261343&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2004.07.061

DO - 10.1016/j.athoracsur.2004.07.061

M3 - Article

C2 - 15734378

AN - SCOPUS:14244261343

VL - 79

SP - 790

EP - 794

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 3

ER -