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Twenty-year experience with acute distal thoracic aortic dissections
Glen Roseborough1, John Burke, Jason Sperry
1Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287-8611, USA. gsrosebo@jhmi.edu
Journal of Vascular Surgery
|August 7, 2004
Summary
Acute dissection of the distal thoracic aorta (ADDA) presents challenges. While surgery is effective for complications, prophylactic therapy may benefit a subset of ADDA patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Aortic Disease
- Vascular Interventions
Background:
- Limited large-scale studies exist on acute distal thoracic aortic dissection (ADDA) outcomes, especially post-percutaneous techniques.
- Evaluating ADDA treatment outcomes is crucial for understanding potential benefits of prophylactic therapies.
Purpose of the Study:
- To assess the clinical outcomes of ADDA patients treated medically, surgically, or percutaneously over 20 years.
- To estimate the potential benefit of future prophylactic therapies for ADDA.
Main Methods:
- Retrospective review of hospital records for all patients admitted with ADDA.
- Analysis of mortality and morbidity rates across different treatment modalities.
Main Results:
- Medical management (92 patients) had 13% mortality; 34% morbidity in survivors.
- Percutaneous interventions (5 patients) showed 40% mortality, effective only for renal artery malperfusion.
- Surgical treatment (22 patients) had 18% mortality; rupture, renal failure, mesenteric ischemia, and age >70 were risk factors for death.
Conclusions:
- ADDA remains a complex condition with treatment failures across medical, surgical, and percutaneous approaches.
- Surgical intervention is effective for ADDA complications, with surgical fenestration offering durable malperfusion treatment.
- A minority of ADDA patients may benefit from prophylactic thoracic stent grafts.