Optimal medical treatment versus endovascular aortic repair in uncomplicated isolated abdominal aortic dissection
Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved..
OBJECTIVE: To report the results of optimal medical treatment (OMT) and endovascular aortic repair (EVAR) in patients with uncomplicated isolated abdominal aortic dissection (IAAD).
METHODS: A retrospective review of 96 consecutive patients with uncomplicated IAAD (uIAAD) managed at a single tertiary vascular unit between January 2011 and July 2021 was conducted. Standard methods for univariate and survival analyses were used. The primary outcomes were all-cause mortality. Secondary end points included uIAAD progression, interventional complications, and follow-up aortic intervention.
RESULTS: Initially, 53.1% of patients (51/96) were managed with OMT. No in-hospital deaths occurred. During follow-up, three patients died, and three and two patients who were initially managed with OMT subsequently required endovascular treatment and surgical management, respectively. Initially, 46.9% of patients (45/96) underwent EVAR. One patient died during hospital admission; nine patients had an endoleak after operation and one needed reintervention. Furthermore, during follow-up, five patients died; four patients needed reoperation, one surgery and three endovascular treatments. The overall long-term mortality was 8.4%, and follow-up aortic intervention rate was 9.5% (median follow-up, 54 months; interquartile range, 33-81 months) with no significant difference between groups. Of note, 12 patients (12.6%) suffered uIAAD progression, which was higher in the OMT group than EVAR group (10 [19.6%] vs 2 [4.5%]; P = .03).
CONCLUSIONS: uIAAD may be managed safely by OMT with regular surveillance, despite the risk of disease progression. Compared with OMT, EVAR could significantly prevent uIAAD progression. For anatomically suitable patients with uIAAD progression and who are unresponsive to OMT, pre-emptive EVAR is a safe and feasible option.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:77 |
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| Enthalten in: |
Journal of vascular surgery - 77(2023), 4 vom: 24. Apr., Seite 1028-1036.e2 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Su, Sheng [VerfasserIn] |
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| Links: |
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| Themen: |
Endovascular aortic repair |
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| Anmerkungen: |
Date Completed 24.03.2023 Date Revised 05.04.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jvs.2022.10.036 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM348466900 |
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| 245 | 1 | 0 | |a Optimal medical treatment versus endovascular aortic repair in uncomplicated isolated abdominal aortic dissection |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 24.03.2023 | ||
| 500 | |a Date Revised 05.04.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVE: To report the results of optimal medical treatment (OMT) and endovascular aortic repair (EVAR) in patients with uncomplicated isolated abdominal aortic dissection (IAAD) | ||
| 520 | |a METHODS: A retrospective review of 96 consecutive patients with uncomplicated IAAD (uIAAD) managed at a single tertiary vascular unit between January 2011 and July 2021 was conducted. Standard methods for univariate and survival analyses were used. The primary outcomes were all-cause mortality. Secondary end points included uIAAD progression, interventional complications, and follow-up aortic intervention | ||
| 520 | |a RESULTS: Initially, 53.1% of patients (51/96) were managed with OMT. No in-hospital deaths occurred. During follow-up, three patients died, and three and two patients who were initially managed with OMT subsequently required endovascular treatment and surgical management, respectively. Initially, 46.9% of patients (45/96) underwent EVAR. One patient died during hospital admission; nine patients had an endoleak after operation and one needed reintervention. Furthermore, during follow-up, five patients died; four patients needed reoperation, one surgery and three endovascular treatments. The overall long-term mortality was 8.4%, and follow-up aortic intervention rate was 9.5% (median follow-up, 54 months; interquartile range, 33-81 months) with no significant difference between groups. Of note, 12 patients (12.6%) suffered uIAAD progression, which was higher in the OMT group than EVAR group (10 [19.6%] vs 2 [4.5%]; P = .03) | ||
| 520 | |a CONCLUSIONS: uIAAD may be managed safely by OMT with regular surveillance, despite the risk of disease progression. Compared with OMT, EVAR could significantly prevent uIAAD progression. For anatomically suitable patients with uIAAD progression and who are unresponsive to OMT, pre-emptive EVAR is a safe and feasible option | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Endovascular aortic repair | |
| 650 | 4 | |a Optimal medical treatment | |
| 650 | 4 | |a Outcomes | |
| 650 | 4 | |a Uncomplicated isolated abdominal aortic dissection | |
| 700 | 1 | |a Liu, Jitao |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Changjin |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Ruirong |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Yuan |e verfasserin |4 aut | |
| 700 | 1 | |a Huang, Wenhui |e verfasserin |4 aut | |
| 700 | 1 | |a Luo, Songyuan |e verfasserin |4 aut | |
| 700 | 1 | |a Yang, Fan |e verfasserin |4 aut | |
| 700 | 1 | |a Luo, Jianfang |e verfasserin |4 aut | |
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