title: Endovascular treatment of acute aortic syndrome.
abstract: BACKGROUND
  The term acute aortic syndrome (AAS) encompasses a range of conditions that have a risk of imminent aortic rupture and where delays in treatment result in increased mortality. Endovascular treatment offers an attractive alternative to open surgery but little is known about the durability of the repair and the factors that predict mortality.
  
  
  METHODS
  Prospective data were collected for a cohort of 110 consecutive patients with endovascular treatment for AAS. Patient and procedural characteristics were related to short- and midterm outcome using multivariate logistic regression analysis.
  
  
  RESULTS
  There were 75 men and 35 women with a median age of 68 (range 57-76) years. The pathologies treated were acute dissection (35), symptomatic aneurysm (32), infected aneurysm (18), transection (12), chronic dissection (9), penetrating ulcer (3), and intramural hematoma (1). Thirty-day mortality was 12.7% and this was associated with hypotension (odds ratio [OR], 5.25), use of general anesthetic (OR, 5.23), long procedure duration (OR, 2.03), and increasing age (OR, 1.07). The causes of death were aortic rupture (4), myocardial infarction (4), stroke (3), and multisystem organ failure (3). The stroke and paraplegia rates were 7.3% and 6.4%, respectively. The 1-year survival was 81% and the 5-year survival 63%. Secondary procedures were required in 13 (11.8%) patients. Factors associated with death at 1 year were presence of an aortic fistula (OR, 9.78), perioperative stroke (OR, 5.87), and use of general anesthetic (OR, 3.76); and at 5 years were aortic fistula (OR, 12.31) and increasing age (OR, 1.06).
  
  
  CONCLUSIONS
  Acute aortic syndrome carries significant early and late mortality. Emergency endovascular repair offers a minimally invasive treatment option associated with acceptable short and midterm results. Continued surveillance is important as secondary procedures and aortic-related deaths continue to occur throughout the follow-up period.
authors.affiliation: Department of Vascular Surgery, NIHR Comprehensive Biomedical Research Centre of Guy's and St. Thomas' NHS Foundation Trust and King's College London, King's Health Partners, London, United Kingdom. rachel.clough@kcl.ac.uk
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Clough
authors.forename: Kevin
authors.initials: K
authors.lastname: Mani
authors.forename: Oliver T
authors.initials: OT
authors.lastname: Lyons
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Bell
authors.forename: Hany A
authors.initials: HA
authors.lastname: Zayed
authors.forename: Matthew
authors.initials: M
authors.lastname: Waltham
authors.forename: Tom W
authors.initials: TW
authors.lastname: Carrell
authors.forename: Peter R
authors.initials: PR
authors.lastname: Taylor
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate; D013577:Syndrome; D016896:Treatment Outcome