TY - JOUR
T1 - Acute type B aortic dissection complicated by visceral ischemia
AU - Jonker, Frederik H.W.
AU - Patel, Himanshu J.
AU - Upchurch, Gilbert R.
AU - Williams, David M.
AU - Montgomery, Daniel G.
AU - Gleason, Thomas G.
AU - Braverman, Alan C.
AU - Sechtem, Udo
AU - Fattori, Rossella
AU - Di Eusanio, Marco
AU - Evangelista, Arturo
AU - Nienaber, Christoph A.
AU - Isselbacher, Eric M.
AU - Eagle, Kim A.
AU - Trimarchi, Santi
N1 - Funding Information:
This work was supported by grants to the International Registry of Acute Aortic Dissection from Gore Medical Inc . (Flagstaff, Ariz); Ann & Bob Aikens ; the University of Michigan Health System (Ann Arbor, Mich); the Varbedian Fund for Aortic Research (Ann Arbor, Mich), the Mardigian Foundation (Bloomfield Hills, Mich), and Medtronic , Inc. (Minneapolis, Minn).
Publisher Copyright:
© 2015 The American Association for Thoracic Surgery.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Objective Acute type B aortic dissection (ABAD) can lead to visceral malperfusion, a potentially life-threatening complication. The purpose of this study was to investigate the presentation, management, and outcomes of ABAD patients with visceral ischemia who are enrolled in the International Registry of Acute Aortic Dissection. Methods Patients with ABAD enrolled in the registry between 1996 and 2013 were identified and stratified based on presence of visceral ischemia at admission. Demographics, medical history, imaging results, management, and outcomes were compared for patients with versus without visceral ischemia. Results A total of 1456 ABAD patients were identified, of which 104 (7.1%) presented with visceral ischemia. Preoperative limb ischemia (28% vs 7%, P <.001) and acute renal failure (41% vs 14%, P <.001) were more common among patients with visceral ischemia. Endovascular treatment and surgery were offered to 49% and 30% of the visceral ischemia cohort, respectively; remaining patients were managed conservatively. The in-hospital mortality was 30.8% for patients with visceral ischemia and 9.1% for those without visceral ischemia (odds ratio [OR] 4.44; 95% confidence interval [CI], 2.8-7.0, P <.0001). Mortality rates were similar after surgical and endovascular management of visceral ischemia (25.8% and 25.5%, respectively, P = not significant). Among the visceral ischemia group, medical management was a predictor of mortality in multivariate analysis (OR, 5.91; 95% CI, 1.2-31.0; P =.036). Conclusions Patients with ABAD complicated by visceral ischemia have a high risk of mortality. We observed similar outcomes for patients treated by endovascular management versus surgery, whereas medical management was an independent predictor of mortality. Early diagnosis and intervention for visceral ischemia seems to be crucial.
AB - Objective Acute type B aortic dissection (ABAD) can lead to visceral malperfusion, a potentially life-threatening complication. The purpose of this study was to investigate the presentation, management, and outcomes of ABAD patients with visceral ischemia who are enrolled in the International Registry of Acute Aortic Dissection. Methods Patients with ABAD enrolled in the registry between 1996 and 2013 were identified and stratified based on presence of visceral ischemia at admission. Demographics, medical history, imaging results, management, and outcomes were compared for patients with versus without visceral ischemia. Results A total of 1456 ABAD patients were identified, of which 104 (7.1%) presented with visceral ischemia. Preoperative limb ischemia (28% vs 7%, P <.001) and acute renal failure (41% vs 14%, P <.001) were more common among patients with visceral ischemia. Endovascular treatment and surgery were offered to 49% and 30% of the visceral ischemia cohort, respectively; remaining patients were managed conservatively. The in-hospital mortality was 30.8% for patients with visceral ischemia and 9.1% for those without visceral ischemia (odds ratio [OR] 4.44; 95% confidence interval [CI], 2.8-7.0, P <.0001). Mortality rates were similar after surgical and endovascular management of visceral ischemia (25.8% and 25.5%, respectively, P = not significant). Among the visceral ischemia group, medical management was a predictor of mortality in multivariate analysis (OR, 5.91; 95% CI, 1.2-31.0; P =.036). Conclusions Patients with ABAD complicated by visceral ischemia have a high risk of mortality. We observed similar outcomes for patients treated by endovascular management versus surgery, whereas medical management was an independent predictor of mortality. Early diagnosis and intervention for visceral ischemia seems to be crucial.
UR - http://www.scopus.com/inward/record.url?scp=84928205008&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2014.11.012
DO - 10.1016/j.jtcvs.2014.11.012
M3 - Article
C2 - 25500101
AN - SCOPUS:84928205008
SN - 0022-5223
VL - 149
SP - 1081-1086.e1
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 4
ER -