title: Emergency endovascular stent grafting in acute complicated type B dissection.
abstract: OBJECTIVE
  The objective of this study was to assess midterm results of emergency endovascular stent grafting for patients with life-threatening complications of acute type B aortic dissection.
  
  
  METHODS
  Between March 1999 and November 2011, 110 patients (86 men, 24 women) with complications of acute type B aortic dissection (mean age, 61 years; range, 19-87 years) were treated with thoracic endovascular aortic repair for malperfusion (55.5%) or aortic rupture (53.6%) in five major European referral centers and one U.S. referral center. Additional comorbidities included hypertension in 90 patients (82%), diabetes in 14 patients (13%), and chronic obstructive pulmonary disease in six patients (6%). Eleven patients (10%) had undergone previous aortic surgery.
  
  
  RESULTS
  Overall hospital mortality was 12% (n = 13), with 14 late deaths after hospital discharge. In-hospital complications occurred in 32 patients (36%); 10 patients developed postoperative renal failure, five patients experienced new permanent neurologic symptoms, and six patients (5.4%) experienced retrograde type A aortic dissection. Furthermore, nine patients (8%) developed an early type I endoleak. Actuarial survival at 1 and 5 years was 85% and 73%, respectively. Postprocedural computed tomography angiography showed complete or partial thrombosis of the false lumen at the stent graft level in 61% and 23% of all patients, respectively. Freedom from treatment failure according to the Stanford classification was 82%, 75%, and 59% at 1, 3, and 5 years.
  
  
  CONCLUSIONS
  Endovascular repair of complicated acute type B aortic dissection is proven to be a technically feasible and effective treatment modality in this relatively difficult patient cohort. Short-term and midterm results are persuasive; however, the long-term efficacy needs to be further evaluated.
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: dominik.wiedemann@meduniwien.ac.at.
authors.forename: Dominik
authors.initials: D
authors.lastname: Wiedemann
authors.affiliation: Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
authors.forename: Marek
authors.initials: M
authors.lastname: Ehrlich
authors.affiliation: Department of Vascular Surgery, Hôpital de la Timone, Marseille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Amabile
authors.affiliation: Cardiovascular Department, Unit of Cardiovascular Radiology, University Hospital S. Orsola, Bologna, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Lovato
authors.affiliation: Department of Radiology, University Hospital Rangueil, Toulouse, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Rousseau
authors.affiliation: Department of Cardiology, General Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Evangelista-Masip
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, Pa.
authors.forename: Patrick
authors.initials: P
authors.lastname: Moeller
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, Pa.
authors.forename: Joseph
authors.initials: J
authors.lastname: Bavaria
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / 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; D004630:Emergencies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005060:Europe; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult