title: Thoracic aortic stent-grafting for acute, complicated, type B aortic dissections.
abstract: BACKGROUND
  To report a single-center experience of aortic stent-grafting for the treatment of acute, complicated, type B aortic dissections.
  
  
  METHODS
  A retrospective review was conducted of the data obtained from all patients who underwent endovascular stent-grafting for acute, type B aortic dissection between 2006 and 2009. The primary and secondary endpoints were 30-day mortality and morbidity rates, respectively.
  
  
  RESULTS
  In all, 104 thoracic endovascular aortic aneurysm repairs were performed during the study period. Nine (8.6%) patients (six men; mean age: 65 years) underwent thoracic endovascular aortic aneurysm repair for acute, complicated, type B aortic dissections. Seven (78%) patients had uncontrolled hypertension on presentation. Visceral branch vessel involvement of the dissection was limited to the celiac axis origin in one patient with no evidence of visceral malperfusion. The indication for repair was aortic rupture in five patients, renal malperfusion in two, and persistent pain in the remaining two. Average time taken from presentation to surgery was 5.5 days. Two patients presenting with aortic ruptures had retrograde extension of the dissection that required replacement of the aortic valve and ascending aorta. The mean length of thoracic aorta covered was 21 cm. Complete coverage of the left subclavian artery was required in three patients and partial coverage in two. On completion angiogram, two type I endoleaks were detected, one of which was resolved by postoperative day 5. The 30-day mortality rate was 22%. One mortality was secondary to aortic rupture. The other mortality was due to multiorgan system failure. Seven patients (78%) had one or more major complications. There were no strokes or paraplegia.
  
  
  CONCLUSIONS
  The association of morbidity and mortality with endovascular stent-grafting for acute, complicated, type B aortic dissections is significant, which most likely reflects the lethal nature of the disease. The precise role of endovascular treatment in these patients remains to be defined.
authors.affiliation: Aortic Center, Cardio-Vascular Thoracic Institute, The University of Southern California, Department of Surgery, 1520 S. San Pablo St., Los Angeles, CA 90033, USA.
authors.forename: Sung Wan
authors.initials: SW
authors.lastname: Ham
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Rowe
authors.forename: Christian
authors.initials: C
authors.lastname: Ochoa
authors.forename: Terry
authors.initials: T
authors.lastname: Chong
authors.forename: William M
authors.initials: WM
authors.lastname: Lee
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Baker
authors.forename: Robbin G
authors.initials: RG
authors.lastname: Cohen
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Cunningham
authors.forename: Fred A
authors.initials: FA
authors.lastname: Weaver
authors.forename: Karen
authors.initials: K
authors.lastname: Woo
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome