title: Endovascular treatment of acute complications associated with aortic dissection: midterm results from a multicenter study.
abstract: OBJECTIVE
  To evaluate endovascular procedures in the management of acute ischemic complications and rupture of the false lumen in aortic dissections.
  
  
  METHODS
  Data on patients with aortic dissection and noncardiac acute complications (peripheral ischemia or thoracic aortic rupture) treated with endovascular techniques were collected from 10 institutions and retrospectively analyzed. From March 1997 to January 2000, 58 patients (50 men; mean age 59.6+/-12.8 years) were treated for 19 (33%) type A and 39 (67%) type B dissections. Twelve (21%) patients had thoracic aortic rupture; 46 (79%) patients had one or more peripheral ischemic complications that included bowel pain (19, 41%), anuria associated with acute renal insufficiency (18, 39%), lower limb ischemia (15, 33%), and/or uncontrolled hypertension with renal ischemia (14, 30%).
  
  
  RESULTS
  In the thoracic rupture cohort, all 12 patients were treated successfully with stent-grafts; one distal endoleak required a secondary procedure. There were 2 (12%) periprocedural deaths; one patient developed transient paraplegia after a secondary surgical procedure. In the 46 patients treated with stent implantation, fenestration, or both for peripheral ischemic symptoms, 44 (96%) had patency restored to the malperfused vessel. Eight (17%) patients died within 30 days. Over a mean follow-up of 8.2+/-8.9 months, the false lumen had thrombosed in 7 (70%) of the stent-graft patients. In the 38 surviving ischemic patients, the diameters of the true and false lumens and maximum transverse aorta all increased; only 4 (11%) had total thrombosis of the false lumen.
  
  
  CONCLUSIONS
  Endovascular treatment of noncardiac acute complications associated with aortic dissection has favorable early and midterm outcomes.
authors.affiliation: Lille Cardiologic University Hospital, France. jpberegi@chru-lille.fr
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Beregi
authors.forename: Stéphan
authors.initials: S
authors.lastname: Haulon
authors.forename: Philippe
authors.initials: P
authors.lastname: Otal
authors.forename: Frédéric
authors.initials: F
authors.lastname: Thony
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Bartoli
authors.forename: Dominique
authors.initials: D
authors.lastname: Crochet
authors.forename: Pascal
authors.initials: P
authors.lastname: Lacombe
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bonneville
authors.forename: Francis
authors.initials: F
authors.lastname: Besse
authors.forename: Philippe
authors.initials: P
authors.lastname: Douek
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Heautot
authors.forename: Hervé
authors.initials: H
authors.lastname: Rousseau
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D000784:Aortic Dissection / Q000150:complications* / Q000601:surgery*; D017130:Angioplasty; D001014:Aortic Aneurysm / Q000150:complications* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome