title: Percutaneous interventions for treating ischemic complications of aortic dissection.
abstract: The aim of this study was to evaluate the role of percutaneous interventions in treating ischemia complicating aortic dissection. Forty-five patients with ischemia complicating aortic dissection were treated by balloon fenestration, true lumen stenting, angioplasty, or thrombolysis. Clinical and laboratory examinations were performed before and after intervention, and at the end of follow-up (median 37 months). Eighteen dissections were acute, 9 sub-acute, and 18 chronic. Mesenterohepatic ischemia resolved in 16 of 18 patients; lactate and SGOT values fell from 2.89 to 1.23 mmol/L (p=0.006) and from 165.9 to 59.7 U/L (p=0.034), respectively. In patients with renal ischemia, creatinine levels fell from 360.1 to 196.3 micromol/L (p=0.007) accompanied by a significant reduction in blood pressure. Limb-threatening ischemia resolved in three of four patients; in 21 claudicants, the mean walking distance improved from 272 to 1,283 m (p=0.001). Spinal ischemia resolved completely or partially in six of eight patients. Adjunctive surgical measures were necessary in six patients. Overall 30-day mortality in the 45 patients was 6.7%; all three deaths were in patients with acute dissections (mortality in this subgroup 16.7%). Ischemia complicating aortic dissection can be effectively treated by percutaneous interventions resulting in good early and mid-term outcomes.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Klinikum Oldenburg, Rahel Straus Str. 10, 26133 Oldenburg, Germany. chavan.ajay@klinikum-oldenburg.de
authors.forename: Ajay
authors.initials: A
authors.lastname: Chavan
authors.forename: Herbert
authors.initials: H
authors.lastname: Rosenthal
authors.forename: Lars
authors.initials: L
authors.lastname: Luthe
authors.forename: Stefanie
authors.initials: S
authors.lastname: Pfingsten
authors.forename: Ingo
authors.initials: I
authors.lastname: Kutschka
authors.forename: Jerry
authors.initials: J
authors.lastname: Easo
authors.forename: Siegfried
authors.initials: S
authors.lastname: Piepenbrock
authors.forename: Otto
authors.initials: O
authors.lastname: Dapunt
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Michael
authors.initials: M
authors.lastname: Galanski
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery* / Q000628:therapy; D017130:Angioplasty / Q000379:methods; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery* / Q000628:therapy; D003287:Contrast Media / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media