Endovascular treatment of isolated abdominal aortic dissections: long-term results.

Abstract

PURPOSE:

To examine long-term survival and freedom from reintervention after endovascular treatment of patients with isolated abdominal aortic dissections (IAAD).

METHODS:

A retrospective review was conducted of 21 patients (18 men; mean age 72±18 years, range 34-90) with an IAAD who underwent endovascular treatment between January 2000 and December 2012. Fourteen patients had spontaneous abdominal dissections, while 7 dissections were iatrogenic in origin. Thirteen patients with symptomatic acute (n=9) or subacute (n=4) lesions underwent analgesic therapy and medical management of systolic blood pressure for at least 5 days; persistent pain was an indication for endovascular treatment. Eight patients with chronic dissections were treated by endovascular means for co-existent (1) abdominal aortic aneurysm (AAA) that was >5 cm in diameter or had expanded >5 mm in 6 months (n=6) or (2) rupture-threatening penetrating aortic ulcer (PAU, n=2) even with a diameter <5 cm. Mean dissection length was 45±12 mm (range 18-98). Ten patients received tube stent-grafts, 9 had bifurcated endografts, one had an aortouni-iliac (AUI) endoprosthesis, and one patient was treated with a bare metal stent. Follow-up included computed tomographic angiography within 1 month postoperatively, duplex ultrasound at 3 and 6 months, CTA at 12 months, and then annual duplex scans.

RESULTS:

Early (30-day) mortality was 0%; no major adverse events occurred during hospitalization. Patients with co-existent AAA/PAU had complete exclusion of the aneurysm sac. The patient with an AUI graft suffered from an early stent-graft thrombosis in the abdominal aorta; flow was restored after transfemoral thrombectomy and balloon angioplasty of the common iliac artery. During a mean 73±22-month follow-up (range 19-144), 3 patients died due to unrelated causes (95% survival at a median 67 months estimated by Kaplan-Meier analysis). All patients showed full aortic remodeling over a period of 12 years. One patient with AAA underwent surgical conversion due to persistent type II endoleak (95% freedom from reintervention at a median 67 months).

CONCLUSION:

In this series, long-term evaluation of endovascular IAAD treatment found no mortality, few complications, and rare need for secondary interventions.

• Authors: Najib Jawadi, Theodosios Bisdas, Giovanni Torsello, Konstantinos Stavroulakis, Konstantinos P Donas
• Journal: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (J Endovasc Ther) Vol. 21 Issue 2 Pg. 324-8 (Apr 2014) ISSN: 1545-1550 [Electronic] United States
• PMID: 24754294 (Publication Type: Evaluation Study, Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Aortic Dissection (diagnosis, mortality, surgery)
• Aortic Aneurysm, Abdominal (diagnosis, mortality, surgery)
• Aortography (methods)
• Blood Vessel Prosthesis
• Blood Vessel Prosthesis Implantation (adverse effects, instrumentation, mortality)
• Endovascular Procedures (adverse effects, instrumentation, mortality)
• Female
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Postoperative Complications (therapy)
• Prosthesis Design
• Retrospective Studies
• Risk Factors
• Stents
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome
• Ultrasonography, Doppler, Duplex