title: [The indication and time of treatment of thoracic endovascular aortic repair in acute Stanford B dissection].
abstract: OBJECTIVE
  To study the indication of thoracic endovascular aortic repair (TEVAR) in acute Stanford B dissection.
  
  
  METHODS
  From February 2004 to June 2008, 464 cases of Stanford B dissection (391 males and 73 females, age from 26 to 88 with a mean of 56.6 years) underwent TEVAR. Patients were divided into group A (acute, n=298) and group B (chronic, n=166). Risk factors of rupture were evaluated and results were compared between the two groups.
  
  
  RESULTS
  The incidence of persistent or recurrent pain and hemothorax in ruptured patients was 83.3% and 94.4%, greater than 10.4% and 14.1% in the non-ruptured patients (P<0.01). The mean maximal diameter of the descending thoracic aorta in the rupture group was 49.4 mm, greater than 35.1 mm in the non-rupture group (P<0.01). Aortic branch vessel ischemia was greatly alleviated after TEVAR. Resolution of the proximal false lumen was 51.7% in group A, 19.5% in group B, and the rate of patent distal false lumen was 59.2% in group A, 79.3% in group B (P<0.01). Four out of 24 cases of intramural hematoma had recurrent dissection.
  
  
  CONCLUSIONS
  Acute dissection with a patent proximal false lumen is an indication for TEVAR. Intramural hematoma could be given medical treatment under close follow-up. Persistent or recurrent pain, hemothorax, descending thoracic aorta greater than 4.5 cm, or aortic branch vessels ischemia warrant prompt TEVAR.
authors.affiliation: Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Jun-hao
authors.initials: JH
authors.lastname: Jiang
authors.forename: Ying-hao
authors.initials: YH
authors.lastname: Ji
authors.forename: Da-qiao
authors.initials: DQ
authors.lastname: Guo
authors.forename: Bin
authors.initials: B
authors.lastname: Chen
authors.forename: Jue
authors.initials: J
authors.lastname: Yang
authors.forename: Zhi-hui
authors.initials: ZH
authors.lastname: Dong
authors.forename: Yun
authors.initials: Y
authors.lastname: Shi
authors.forename: Yu-qi
authors.initials: YQ
authors.lastname: Wang
authors.forename: Wei-guo
authors.initials: WG
authors.lastname: Fu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome