title: Endovascular treatment of isolated abdominal aortic dissections: long-term results.
abstract: OBJECTIVE
  To examine long-term survival and freedom from reintervention after endovascular treatment of patients with isolated abdominal aortic dissections (IAAD).
  
  
  METHODS
  A retrospective review was conducted of 21 patients (18 men; mean age 72±18 years, range 34-90) with an IAAD who underwent endovascular treatment between January 2000 and December 2012. Fourteen patients had spontaneous abdominal dissections, while 7 dissections were iatrogenic in origin. Thirteen patients with symptomatic acute (n=9) or subacute (n=4) lesions underwent analgesic therapy and medical management of systolic blood pressure for at least 5 days; persistent pain was an indication for endovascular treatment. Eight patients with chronic dissections were treated by endovascular means for co-existent (1) abdominal aortic aneurysm (AAA) that was >5 cm in diameter or had expanded >5 mm in 6 months (n=6) or (2) rupture-threatening penetrating aortic ulcer (PAU, n=2) even with a diameter <5 cm. Mean dissection length was 45±12 mm (range 18-98). Ten patients received tube stent-grafts, 9 had bifurcated endografts, one had an aortouni-iliac (AUI) endoprosthesis, and one patient was treated with a bare metal stent. Follow-up included computed tomographic angiography within 1 month postoperatively, duplex ultrasound at 3 and 6 months, CTA at 12 months, and then annual duplex scans.
  
  
  RESULTS
  Early (30-day) mortality was 0%; no major adverse events occurred during hospitalization. Patients with co-existent AAA/PAU had complete exclusion of the aneurysm sac. The patient with an AUI graft suffered from an early stent-graft thrombosis in the abdominal aorta; flow was restored after transfemoral thrombectomy and balloon angioplasty of the common iliac artery. During a mean 73±22-month follow-up (range 19-144), 3 patients died due to unrelated causes (95% survival at a median 67 months estimated by Kaplan-Meier analysis). All patients showed full aortic remodeling over a period of 12 years. One patient with AAA underwent surgical conversion due to persistent type II endoleak (95% freedom from reintervention at a median 67 months).
  
  
  CONCLUSIONS
  In this series, long-term evaluation of endovascular IAAD treatment found no mortality, few complications, and rare need for secondary interventions.
authors.affiliation: 1 Clinic for Vascular and Endovascular Surgery, St. Franziskus Hospital, Münster, Germany.
authors.forename: Najib
authors.initials: N
authors.lastname: Jawadi
authors.forename: Theodosios
authors.initials: T
authors.lastname: Bisdas
authors.forename: Giovanni
authors.initials: G
authors.lastname: Torsello
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stavroulakis
authors.forename: Konstantinos P
authors.initials: KP
authors.lastname: Donas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / 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; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex