medigraphic.com
Órgano Oficial de la Sociedad Mexicana de Angiología y Cirugía Vascular

2005, Number 1

<< Back Next >>

Rev Mex Angiol 2005; 33 (1)

Experience in surgical and vascular treatment of the aortic dissection type B in the specialties’Hospital National Medical Center XXI Century

Martínez LC, Sánchez MB, Piña GSL, Torres SNA, Gil RL

Language: Spanish
References: 33
Page: 6-12
PDF size: 486.15 Kb.


ABSTRACT

Background: Aortic dissection is one of the most catastrophic events that affects the aortic wall; the incidence is difficult to determine because many of these cases are not correctly diagnosed and they still have an elevated mortality in our country.
Objective: To communicate our experience in the surgical and endovascular treatment of the type B of Standford aortic dissection at the Hospital of Specialties Century XXI.
Methods: From November 2001 to November 2004 eleven patients with aortic dissection type B received treatment, there were 9 (81.81%) men and 2 (18.18%) women with a range of age between 37 to 75 years. Of these 3 (27.2%) had acute dissection and 8 (72.8%) with chronic dissection, the image studies used for diagnosis were digital angiography, computed tomography, magnetic resonance and transesophageal echocardiography.
Results: Endovascular treatment was used in 3 (27.2%) patients, delivering a stent graft in the descendent thoracic aorta and open surgery in the 8 (72.8%) of them, in this last group 2 deaths occurred resulting in a mortality of 18.18%.
Conclusion: Patients with aortic dissection still have a high mortality principally in the acute dissections. Endovascular therapy has lowered the morbility and mortality in high risk patients and acute dissections. We still require long term follow-up data that corroborate its efficacy.


REFERENCES

  1. Sans S, Kesteloot H, Kromhout D on behalf of the Task Force. Task Force of the European Society of Cardiology on cardiovascular mortality and morbidity statics. Europe. Eur Heart J 1997; 18 : 1231-48.

  2. Beighton P, de Paepe A, Danks D, and 17 coauthors. International nosology of hereditable disorders of connective tissue. Berlin 1986. Am J Med Genet 1988; 29: 581-94.

  3. De Paepe A, Devereux R, Dietz H, Hennekam R, Pyeritz R. Revised diagnostic criteria for the Marfan syndrome. Am J Med Genet 1996; 62: 417-26.

  4. Dalgeish R. The human collagen mutation database 1998. Nucleic Acids Res 1998; 26: 253-5.

  5. Collagen database: http//www.Le.ac.uk.genetic/collagen.

  6. Collod G, Babron MC, Jondeau G, et al. A second locus for Marfan syndrome maps to chromosome 3p24.2-p25. Nat Genet 1994; 264-8.

  7. Young R, Ostertag H. Incidence etiology and risk of rupture of aortic aneurysm. An autopsy. Dtsch Med Wschr 1987; 112: 1253-6.

  8. Reed D, Reed C, Stemmermann G, Hayashi T. Are aortic aneurysms caused by atherosclerosis? Circulation 1992; 85: 205-11.

  9. Parmley LF, Mattingly TW, Manion WC, Jahuke EJ, Non penetrating traumatic injury of the aorta. Circulation 1958; 17: 1086-101.

  10. Moles VP, Chappius F, Simonet F, Urban P, De la Serna F, Pande AK, Meier B. Aortic dissection as complication of percutaneous transluminal coronary angioplasty. Cathet Cardiovasc Diagn 1992; 26: 8-11.

  11. Leu HJ. Classification of vasculitis. A survey. Vasa 1995; 24: 319-24.

  12. Churg A, Churg J. Systemic vasculitides, 1st Ed. New York. Tokyo: Igaku-Shoin; 1991.

  13. Grannis FW Jr, Bryant C, Caffaratti JD, Turner AF. Acute aortic dissection associated with cocaine abuse. Clin Cardiol 1988; 11: 572-4.

  14. Rashid J, Eisenberg MJ, Topol EJ. Cocaine induced aortic dissection. Am Heart J 1996; 136: 1301-4

  15. Fann J, Sarris G, Mitchell R, Shumway N, Stinson E, Oyer P. Treatment of patients with aortic dissections presenting with peripheral vascular complications. Ann Surg 1990; 212: 705-13.

  16. Fann J, Smith J, Miller D, Mitchell R, Moore K, Grukeimer G. Surgical management of aortica dissection during a 30-year period. Circulation 1995; 92: 1114-20.

  17. Slater EE, De Sanctis RW. The clinical recognition of dissecting aortic aneurysm. Am J Med 1976; 60: 625-33.

  18. Hagan PG, Nienaber CA, Isselbacher EM, et al. The internacional registry of acute aortic dissection (IRAD): new insights into an old disease. JAMA 200; 283: 897-903.

  19. Fraser CD, Wang N, Mee RB, et al. Repair of insufficient bicuspid aortic valves. Ann Thorac Surg 1994; 58: 386-90.

  20. Gott VL, Cameron DE, Pyeritz RE et al. Composite graft repair of Marfan aneurysm of the ascendig aorta: results in 150 patients. J Card Surg 1994; 482-9.

  21. Kouchoukos NT, Wareing TH, Murphy SF, Perrillo JB. Sixteen-year experience with aortic root replacement. Results in 172 operations. Ann Surg 1991; 214: 308-18: discussion 318-20.

  22. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax 1968; 23: 338-9.

  23. Kouchokos NT, Karp RB, Blackstone EH, Kirklin JW, Pacifico AD, Zorn GL. Replacement of the ascending aorta and aortic valve with a composite graft. Results in 86 patients. Ann Surg 1980; 192: 403-13.

  24. David TE, Feindel CM. An aortic valve sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg 1992; 103: 617-21; discussion 622.

  25. Sarsam MA, Yacoub M. Remodeling of the aortic valve annulus. J Torca Cardiovasc Surg 1993; 105: 435-8.

  26. Bachet J, Gigou F, Laurean C, Bical O, Goudot B, Guilmet D. Tour year clinical experience with the gelatin resorcine formol biological glue in acute aortic dissection. J Thorac Cardiovasc 1982; 83: 212-7.

  27. Pego-Fernandes PM, Stolf NA, Moreira LF, Pereira Barreto AC, Bittencourt D, Jatene AD. Management of aortic insufficiency in chronic aortic dissection. Ann Torca Surg 1991; 51: 438-42.

  28. Frater RW. Aortic valve insufficiency due to aortic dilatation: correction by sinus rim adjustment. Circulation 1986; 74 (I): 136-42.

  29. Ergin MA, O´Connor J, Guinto R, Griepp RB. Experience with profound hypothermia and circulatory arrest in the treatment of aneurysms of the aortic arch. Aortic arch replacement for acute aortic dissections. J Thorac Cardiovasc Surg 1982; 84: 649-55.

  30. Heineman M, Lass J, Jurmann M, Karck M, Borst HG. Surgery extended into the aortic arch in acute type A dissection. Indications, techniques and results. Circulation 1991; 84(III): 25-30.

  31. Slonim SM, Miller D, Mitchell R, Semba CP, Razavi M, Dake MD. Percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissections. J Thoracic Cardiovasc Surg 1999; 117(6): 1118-26.

  32. Roger M Greenhalg. Thoracic aneurysm and type B dissections should be treated by stent-graft. Roger M. Greenhalg, editor. The Evidence for vascular or endovascular reconstruction. 1a. Ed. London, UK: WB Saunders; 2002, p. 138.

  33. 33. Jason TL, Rodney AW. Endografting for thoracic aneurysm has replaced the need for open surgery. Greenhalg, RM (ed.). Vascular and endovascular controversies. 1a. Ed. London, UK: BIBA publishing; 2003, p. 189-197.




2020     |     www.medigraphic.com