title: Own clinical observations of treatment outcome in acute type B aortic dissection.
abstract: The aim of the study was to analyse early results of treatment of acute type B aortic dissection.
  
  
  METHODS
  59 patients, treated between 1998 and 2011, were divided into four groups. Group I comprised ten patients in whom hybrid procedures were performed: extra-anatomical by-pass graft from the brachio-cephalic trunk to the left carotid artery in six patients, transposition of the left carotid artery to the right one in two patients, and reversed Y prosthesis from the brachio-cephalic trunk to both carotids in the remaining 2 patients, to facilitate stent-grafting. Group II comprised 13 patients in whom endovascular procedures were performed (stent-grafting). Group III comprised 21 patients in whom conventional surgery was done. Group IV comprised 15 patients who were treated conservatively.
  
  
  RESULTS
  In group I, a very good clinical outcome, without complications, was achieved in six patients (60% of cases). The total mortality rate was 40%. One patient died on the operation table, following stent-grafting, due to the rupture of the aortic arch. Two patients died as a result of brain damage (cerebral aneurysm rupture in one, and ischemic stroke in the other). In one patient, an aorto-oesophageal fistula developed. In group II, one patient died during endovascular procedure. Another patient suffered from type 1 endoleak, requiring repeated endovascular surgery. In group III, 15 patients (72%) died. Moreover, four patients required acorrective cardiac surgery (Bentall procedure)which in three patients resulted in death. Thus, the total mortality rate in this group was as high as 85%. In group IV, the mortality rate was 13%.
  
  
  CONCLUSIONS
  We noticed a clear superiority of endovascular procedures over conventional surgeries-for acute type B aortic dissection. Hybrid procedures for acute, complicated type B aortic dissection evidently reduce mortality and postoperative morbidity. Uncomplicated acute type B aortic dissections should be treated conservatively at intensivecare units.
authors.affiliation: Department of Surgery, 4th Military Clinical Hospital, Wrocław.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Janczak
authors.forename: Jan
authors.initials: J
authors.lastname: Skóra
authors.forename: Jerzy
authors.initials: J
authors.lastname: Garcarek
authors.forename: Andrzej
authors.initials: A
authors.lastname: Litarski
authors.forename: Marcim
authors.initials: M
authors.lastname: Merenda
authors.forename: Artur
authors.initials: A
authors.lastname: Wieraszko
mesh_terms: D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications; D015607:Stents; D016896:Treatment Outcome