Outcome and Complications of Type B Aortic Dissection Matt Thompson
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MMT BCIS/BSET‘08 Outcome and Complications of Type B Aortic Dissection Matt Thompson St George’s Vascular Institute, London
description
Outcome and Complications of Type B Aortic Dissection Matt Thompson St George’s Vascular Institute, London. Changing Management Algorithm. Tsai et al Circulation 2005. Temporal Classification. Acute < 14 days Chronic > 14 days Sub-acute: 2-6 weeks. Acute Type B Thoracic Dissection. - PowerPoint PPT Presentation
Transcript of Outcome and Complications of Type B Aortic Dissection Matt Thompson
MMT BCIS/BSET‘08
Outcome and Complications of
Type B Aortic Dissection
Matt Thompson
St George’s Vascular Institute, London
MMT BCIS/BSET‘08
Changing Management Algorithm
MMT BCIS/BSET‘08
MMT BCIS/BSET‘08
MMT BCIS/BSET‘08
Tsai et al Circulation 2005
MMT BCIS/BSET‘08
Temporal Classification
Acute < 14 days
Chronic > 14 days
Sub-acute: 2-6 weeks
MMT BCIS/BSET‘08
Acute Type B Thoracic Dissection
Uncomplicated
Complicated
MMT BCIS/BSET‘08
Acute Type B Thoracic Dissection
Uncomplicated
Complicated
Rupture
Impending rupture (unremitting pain / hypertension)
Visceral ischaemia
Limb ischaemia
MMT BCIS/BSET‘08
MMT BCIS/BSET‘08
Suzuki et al Circulation 2003
MMT BCIS/BSET‘08
Prevent Death in Acute Setting
159 patients acute Type B dissection
Default medical management p / t
Complicated dissection 47% - mortality 18%
Uncomplicated dissection 53% - mortality 1.2%
Estera et al Ann Thorac Surg 2007
MMT BCIS/BSET‘08
MMT BCIS/BSET‘08
MMT BCIS/BSET‘08
50
60
70
80
90
100
0 6 12 18 24 30 36 42 48 54 60 66 72
Time (months)
Surv
ival
(%)
Acute Type B dissectionChronic Type B dissection
Endovascular Treatment of Type B Dissection - Survival
MMT BCIS/BSET‘08
Chronic Type B Thoracic Dissection
Uncomplicated
Complicated
MMT BCIS/BSET‘08
Chronic Type B Thoracic Dissection
Uncomplicated
Complicated
Rupture / end organ ischaemia
Retrograde Type A dissection
Aortic dilatation > 6cm
MMT BCIS/BSET‘08
Long Term Prospective Data – Type B
66 patients Type B – no surgical intervention
82% remained free of dissection related death 10y
14% died from aortic disease
7.5% Type A dissection
15% exceeded 6 cm
Winnerkvist et al EJVES 2006
MMT BCIS/BSET‘08
MMT BCIS/BSET‘08
Nienaber – Veith Symposium 2006
Mortality Following Endovascular Repair
MMT BCIS/BSET‘08
Factors Predicting Expansion
Soong et al JACC 2007
MMT BCIS/BSET‘08
Indications for Intervention
Acute - complicated
Chronic - complicated / dilated
Sub-acute - sub group??
