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Early and Long-term Outcome after Open Surgical Suprarenal Aortic Fenestration in Patients with Complicated Acute
Z Szeberin1, E Dósa1, M Fehérvári1
1Department of Vascular Surgery, Cardiovascular Centre, Semmelweis University, Budapest, Hungary.
Insights
Open surgical suprarenal aortic fenestration (OSSAF) for complicated acute type B aortic dissection has acceptable early mortality and low paraplegia rates. However, late mortality remains a concern, often linked to aortic rupture.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
- Aortic Diseases
Background:
- Complicated acute type B aortic dissection (CABAD) presents significant mortality and morbidity risks.
- Traditional open surgical repair and newer endovascular techniques are treatment options.
- Open surgical suprarenal aortic fenestration (OSSAF) is an alternative for specific CABAD cases.
Purpose of the Study:
- To evaluate early and long-term mortality and morbidity in CABAD patients treated with OSSAF.
- To identify risk factors affecting long-term prognosis after OSSAF.
- To compare OSSAF outcomes with other treatment modalities for CABAD.
Main Methods:
- Retrospective cohort study of 52 CABAD patients treated between 2002 and 2008.
- Forty-two patients underwent OSSAF; ten had aortic graft replacement.
- Follow-up included clinical examination and computed tomography angiography for up to 84 months.
Main Results:
- Indications for OSSAF included malperfusion (40%), pain/hypertension (50%), and false lumen enlargement (10%).
- Thirty-day mortality was 21.4%; 5-year survival was 70.6%.
- Late mortality (19%) was primarily due to aortic rupture; no paraplegia occurred. Nine patients (21%) required further intervention.
Conclusions:
- OSSAF offers acceptable early mortality and a low rate of paraplegia in CABAD.
- Late mortality is a significant concern, often associated with aortic rupture.
- While stent grafting is preferred, OSSAF remains a viable option for select patients unsuitable for endovascular repair.
Objectives:
The purpose of this retrospective cohort study was to determine the early and long-term mortality and morbidity as well as to reveal risk factors influencing the long-term prognosis in patients with complicated acute type B aortic dissection (CABAD) undergoing open surgical suprarenal aortic fenestration (OSSAF).
Methods:
Fifty-two patients with CABAD, defined as (impending) rupture, acute enlargement of the false lumen, malperfusion, and/or unrelenting back pain or uncontrollable hypertension despite maximum medical therapy were treated with by surgical repair between 2002 and 2008. Ten patients with (impending) rupture had aortic graft replacement, while 42 (33 men, mean age 55 ± 11 years) had OSSAF. Follow up visits were scheduled at 1, 3-6 and 12 months after the surgery and annually thereafter. Clinical examination and computed tomography angiography findings were investigated at baseline and at subsequent visits.
Results:
The indications for OSSAF were acute enlargement of the false lumen in four (10%), malperfusion in 17 (40%) (11 lower extremity [26%], 6 visceral [14%]), and unrelenting back pain or uncontrollable hypertension in 21 cases (50%). The 30 day mortality was 21.4% (2 multiple organ failure, 2 heart failure, 3 pneumonia, 1 intestinal necrosis, 1 major hemorrhage). The mean follow up was 84 ± 40 months. The 5 year survival was 70.6%. Eight patients (19%) died during the follow up period (6 aortic ruptures, 2 myocardial infarctions). None of the patients became paraplegic after the surgery. Further surgery or stenting was indicated in nine cases (21%).
Conclusions:
OSSAF has been performed with an acceptable early mortality and low paraplegia rate, but late mortality is frequently related to aortic rupture. Stentgraft coverage of the primary entry tear decreases late aortic related deaths, but suprarenal fenestration remains an option for cases not suitable for endovascular techniques.
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