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Management of descending aortic dissection
J A Elefteriades1, C J Lovoulos, M A Coady
1Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
The Annals of Thoracic Surgery
|July 3, 1999
Summary
This study reports on 100 patients with acute descending aortic dissection, recommending a complication-specific approach. Alternative procedures like fenestration and thromboexclusion show promise for selected patients with descending aorta dissection.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Reports experience with 100 consecutive patients with acute dissection of the descending aorta.
- Data collected over a 10-year period at the Yale Center for Thoracic Aortic Disease.
Purpose of the Study:
- To analyze treatment strategies and outcomes for acute descending aortic dissection.
- To evaluate the effectiveness of alternative surgical procedures compared to direct aortic replacement.
Main Methods:
- Retrospective analysis of clinical records from 1988 to 1998.
- Inclusion of patient demographics, symptomatology, diagnostic imaging, treatment, and follow-up data.
- Computerized database utilized for comprehensive data collection.
Main Results:
- Average aorta size at dissection was 5.05 cm; 9 patients died.
- Complications in survivors included rupture, vascular occlusion, expansion, and pain.
- 42 patients underwent surgery (direct aortic replacement, fenestration, thromboexclusion) with 6 postoperative deaths and 6 paraplegias.
Conclusions:
- Recommends a complication-specific approach for acute descending aortic dissection.
- Suggests medical management with anti-impulse therapy for uncomplicated cases.
- Advocates for surgical intervention tailored to specific complications, considering alternatives to direct aortic replacement due to high mortality and paraplegia rates.