E-resources
-
Durham, Christopher A., MD; Cambria, Richard P., MD; Wang, Linda J., MD; Ergul, Emel A., MS; Aranson, Nathan J., MD; Patel, Virendra I., MD, MPH; Conrad, Mark F., MD, MSSc
Journal of vascular surgery, 05/2015, Volume: 61, Issue: 5Journal Article
Objective Although medical management of acute uncomplicated type B aortic dissection remains the standard of care, contemporary data regarding the natural history of medically treated patients are sparse. The goal of this study was to evaluate the natural history of patients with acute type B aortic dissection who were initially managed with medical therapy alone. Methods All patients with acute type B aortic dissection who were initially managed medically between March 1999 and March 2011 were included. Failure of medical therapy was defined as any death or aorta-related intervention. Early failure occurred within 15 days of presentation. Predictors of long-term outcomes were determined using backward stepwise regression. Results A total of 298 patients with medically managed acute type B dissections were identified. The cohort had an average age of 65.9 years at presentation and was 61.7% male. There were 174 (58.4%) failures including 119 deaths and 87 interventions (24 endovascular, 63 open); 57 (66%) interventions were performed for aneurysmal degeneration. There were 37 (12%) early failures including 14 deaths and 25 interventions (10 endovascular, 15 open). Aneurysmal degeneration was the indication for intervention in six patients (24%). Mean follow-up was 4.2 years (range, 0.1-14.7 years). Kaplan-Meier estimate demonstrated that freedom from intervention was 77.3% ± 2.4% at 3 years and 74.2% ± 2.5% at 6 years. There were no predictors of freedom from intervention. Kaplan-Meier estimate demonstrated that the intervention-free survival was 55.0% ± 3.0% at 3 years and 41.0% ± 3.2% at 6 years. End-stage renal disease was predictive of failure of medical treatment (hazard ratio, 2.60; confidence interval, 1.19-5.66; P = .02), and age >70 years was protective against failure (hazard ratio, 0.97; confidence interval, 0.95-0.98; P < .01). Kaplan-Meier estimate demonstrated that survival after 6 years was higher in patients who underwent interventions (76% vs 58%; P = .018). Conclusions The majority of patients with acute type B dissection will fail medical therapy over time as evidenced by a 6-year intervention-free survival of 41%. Patients who underwent any aortic intervention had a significant survival advantage over those who were treated with medical management alone. Further study is necessary to determine who will benefit most from early intervention.
![loading ... loading ...](themes/default/img/ajax-loading.gif)
Shelf entry
Permalink
- URL:
Impact factor
Access to the JCR database is permitted only to users from Slovenia. Your current IP address is not on the list of IP addresses with access permission, and authentication with the relevant AAI accout is required.
Year | Impact factor | Edition | Category | Classification | ||||
---|---|---|---|---|---|---|---|---|
JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
Select the library membership card:
If the library membership card is not in the list,
add a new one.
DRS, in which the journal is indexed
Database name | Field | Year |
---|
Links to authors' personal bibliographies | Links to information on researchers in the SICRIS system |
---|
Source: Personal bibliographies
and: SICRIS
The material is available in full text. If you wish to order the material anyway, click the Continue button.