title: Midterm results after endovascular treatment of acute, complicated type B aortic dissection: the Talent Thoracic Registry.
abstract: OBJECTIVE
  To assess the efficacy and midterm results of endovascular treatment of acute complicated type B dissection.
  
  
  METHODS
  From January 1998 to March 2004, 29 patients (7 women and 22 men) with acute complicated aortic type B dissection (mean age, 61 years; range, 22-78), defined as aortic rupture, malperfusion, intractable pain, or uncontrolled hypertension, underwent endovascular stent graft placement with the Medtronic Talent device. Five patients (17%) had undergone previous surgery on the ascending aorta and/or aortic valve. The mean aortic diameter at intervention was 48 ± 13 mm. Follow-up was 100% complete and averaged 53 ± 41 months.
  
  
  RESULTS
  The technical feasibility and success with deployment proximal to the entry tear was 100%, requiring partial or total coverage of the left subclavian artery in only 1 patient (3%). Hospital mortality was 17% ± 7% (70% confidence limit) with 6 late deaths. The causes of hospital death included multiorgan failure in 2 patients, aortic rupture in 2, and retrograde dissection in 1 patient. Three patients (10%) who survived the procedure developed neurologic complications (2 strokes and 1 transient ischemic attack). One patient required early conversion to surgery because of retrograde type A dissection. Furthermore, 4 patients developed a type Ia endoleak. A postprocedural increase in the distal aortic diameter was observed in 3 patients. The actuarial survival at 1 and 5 years was 79% and 61%, respectively. Freedom from treatment failure at 1 and 5 years (including reintervention, aortic rupture, device-related complications, aortic-related death, or sudden, unexplained late death) was 82% and 77%, respectively.
  
  
  CONCLUSIONS
  Endovascular stent graft placement in acute complicated type B aortic dissection proves to be a promising alternative therapeutic treatment modality in this relatively difficult patient cohort. Refinements, especially in stent design and application, could further improve the prognosis of patients in this life-threatening situation.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Vienna, Vienna, Austria. marek.ehrlich@meduniwien.ac.at
authors.forename: Marek P
authors.initials: MP
authors.lastname: Ehrlich
authors.forename: Herve
authors.initials: H
authors.lastname: Rousseau
authors.forename: Robin
authors.initials: R
authors.lastname: Heijmen
authors.forename: Philippe
authors.initials: P
authors.lastname: Piquet
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Beregi
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Gottfried
authors.initials: G
authors.lastname: Sodeck
authors.forename: Rossella
authors.initials: R
authors.lastname: Fattori
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; 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; D005060:Europe; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012042:Registries; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult