Preconception Counseling for Patients With Thoracic Aortic Aneurysms

Purpose of the review

Acute aortic dissection is a potentially catastrophic cardiovascular emergency that is associated with a high mortality rate. Pregnancy, with its attendant hormonal and physiological changes, increases the risk of dissection in women with known thoracic aortic aneurysms. In this review, we highlight the importance of preconception counseling to help women with known thoracic aortic aneurysms better understand their risk of dissection and the heritable nature of thoracic aortic disease and its associated syndromes.

Recent findings

The risk of aortic dissection during pregnancy differs according to the underlying etiology of thoracic aortic aneurysm and the degree of aortic dilatation at baseline. Guideline-specific management of women with thoracic aortic aneurysms in pregnancy reduces their risk of dissection.

Summary

Management of pregnant women with thoracic aortic aneurysms requires an intensive multidisciplinary approach to maximize the chances of a successful outcome for both the mother and fetus. Preconception counseling provides an opportunity to optimize patients medically and to consider potential prophylactic aortic repair prior to pregnancy.

     

Type A dissection following endovascular thoracic aortic stent-graft repair.

PURPOSE: To describe our experience with endovascular stent-graft repairs in the thoracic aorta focusing on the secondary complication of type A dissection. METHODS: Between January 1996 and April 2004, 73 patients were treated for traumatic thoracic aortic rupture (n=15), type B dissection (n=22), or atherosclerotic descending thoracic aortic aneurysms (TAA, n=36). A retrospective review of the records found 5 (6.8%) patients (3 men; median age 64 years, range 43-87) who experienced a type A dissection at a median 20 days (range 2-124) after thoracic stent-graft repair for 3 type B dissections, 1 TAA, and a late type I endoleak that appeared 28 months after initial stent-graft repair of a traumatic dissection. RESULTS: In 3 patients (2 dissections, 1 endoleak), a tear in the aortic wall at the proximal stent-graft was responsible for a retrograde type A dissection. Underlying disease was the cause of the type A dissection in the 2 other patients (1 dissection, 1 TAA) and was unrelated to the stent-grafts. Three patients underwent open surgery at 3, 26, and 124 days after stent-graft placement; 2 procedures were successful, but the third patient died 3 months later due to multiorgan failure. Two type A dissections were untreated: one patient died from cardiac tamponade 14 days after successful stent-graft exclusion of the type I endoleak; the other patient refused further treatment and survived. The procedure-related mortality following acute retrograde type A dissection was 40%. CONCLUSIONS: Endovascular stent-graft repair of the thoracic aorta is associated with lower morbidity and mortality rates than surgical repair, although potentially lethal complications, acute or delayed, may occur.     

One-stage hybrid procedure without sternotomy for treating thoracic aortic pathologies that involve distal aortic arch: a single-center preliminary study

Objective

This study aims to evaluate the initial results of a hybrid procedure without sternotomy for treating descending thoracic aortic disease that involves distal aortic arch. It also intends to report our initial experience in performing this procedure.

Methods

A total of 45 patients (35 males and 10 females) with descending thoracic aortic disease underwent a hybrid procedure, namely, thoracic endovascular aortic repair (TEVAR) combined with supra-arch branch vessel bypass, in our center from April 2009 to August 2014. Right axillary artery to left axillary artery bypass (n=20) or right axillary artery to left common carotid artery (LCCA) and left axillary artery bypass (n=25) were performed. The conditions of all patients were followed up from the 2^nd month to the 65^th month postoperative (mean, 26.0±17.1). Mortality within 30 days, complications such as endoleak after the hybrid procedure, and stenosis or blockage of the bypass graft during the follow-up period was assessed.

Results

All the patients underwent a one-stage procedure. One case of death and one case of cerebral infarction were reported within 30 days. One patient died of the sudden drop in blood pressure during the 2^nd day of operation. Meanwhile, another patient suffered from cerebral infarction. Two patients underwent open surgery, and one of them had to undergo a second TEVAR during the follow-up period. Moreover, endoleak occurred in two patients and a newly formed intimal tear was observed in one patient. Overall, 93.2% of the patients survived without any complication related to the hybrid procedure.

Conclusions

Initial results suggest that the one-stage hybrid procedure is a suitable therapeutic option for thoracic aortic pathologies that involve distal aortic arch. However, this procedure is not recommended for type-B aortic dissection, in which a tear is located in the greater curvature or near the left subclavian artery (LSA), because of the high possibility of endoleak occurrence.     

Endovascular treatment of thoracic aortic disease: mid-term follow-up.

OBJECTIVE: The aim of this study was to evaluate the mid-term follow-up in a cohort of patients with acute or chronic descending aortic disease treated by stent-graft repair. BACKGROUND: Since 1999, endovascular stent-graft placement has been reported as an alternative treatment to surgical approach for a variety of thoracic aortic diseases; however, results beyond initial short-term follow-up are not widely available for the broad range of applications. METHODS: From March 2001, 43 consecutive patients with traumatic aortic transection (group A = 16) and complicated type B aortic dissection or aneurysm (group B = 27) underwent stent-graft implantation. All patients underwent computed tomography (CT) scan as preoperative assessment and in 26 a transesophageal echo (TEE) exam was performed. RESULTS: Technically successful stent-graft deployment was achieved in all patients. No patient required surgical conversion and no cases of paraplegia occurred. The overall in-hospital mortality was 9.3%. A residual endoleak (type II) was detected in one group B patient who was managed conservatively. The mean follow-up was 29 +/- 8 months (range 10-48 months). No patient died during late follow-up after hospital discharge. At 12 months, one patient (2.5%) who had stent graft repair of an aortic dissection developed an asymptomatic type I endoleak. Three asymptomatic patients with chronic dissection had a persistent retrograde perfusion of the thoracic false lumen via a distal tear(s) in the dissection septum. CONCLUSION: Our results of stent-graft treatment of complicated and uncomplicated diseases of the descending aorta confirms that this alternative to open repair is a safe, less invasive, and relatively low risk approach. Medium-term follow-up results suggest that it is effective and durable therapy with low associated mortality and morbidity rates.     

Acute Limited Intimal Tears of the Thoracic Aorta

Background

Limited intimal tears (LITs) of the aorta (Class 3 dissection variant) are the least common form of aortic pathology in patients presenting with acute aortic syndrome (AAS). LITs are difficult to detect on imaging and may be underappreciated.

Long-Term Results of Aortic Banding for Complex Infrarenal Neck Anatomy and Type I Endoleak after Endovascular Abdominal Aortic Aneurysm Repair

For many patients with abdominal aortic aneurysm, unsuitable anatomy of the infrarenal aortic neck precludes endovascular aortic aneurysm repair or causes type I endoleak after the procedure. In an attempt to overcome these challenges, we retrospectively examined the usefulness of aortic banding as an adjunctive procedure to endovascular repair in 8 patients who had an abdominal aortic aneurysm with a complex infrarenal aortic neck. The procedures were performed with the patients under general anesthesia and involved making an 8-cm upper-midline laparotomy incision to expose the aneurysmal aorta. Three patients underwent aortic banding before endovascular repair; the other 5 underwent banding after the repair because of persistent type I endoleak. After banding, the abdominal aortic aneurysm was successfully excluded in all 8 patients. Long-term follow-up (mean, 38 ± 20 mo) revealed no type I endoleak and no procedure-related complications. In patients who have an abdominal aortic aneurysm with complex infrarenal neck anatomy or a refractory type I endoleak, performing aortic banding as an adjunctive procedure to endovascular aortic repair appears to be a safe strategy with good long-term results.Key words: Aortic aneurysm, abdominal/complications/surgery; blood vessel prosthesis implantation/adverse effects/methods; patient selection; postoperative complications; risk factors; stents; treatment outcome; vascular surgical procedures/instrumentationEndovascular abdominal aortic aneurysm repair (EVAR) is a rapidly expanding treatment method for abdominal aortic aneurysm (AAA).¹ Unsuitable anatomy of the infrarenal aortic neck precludes EVAR in many patients,^1–3 and this is the most common reason for EVAR ineligibility and subsequent surgical repair (in 106 of 165 patients in one study).⁴ In addition, investigators have reported that proximal attachment failure after EVAR frequently results in type IA endoleak. When left untreated, this sequela is associated with a high risk of AAA expansion and rupture.^2–5 Various endovascular methods of reinforcing the neck from the inside have yielded largely unsatisfactory results.^6,7 The failure of endovascular intervention often necessitates surgical repair and removal of the endograft, which increases the morbidity and mortality associated with EVAR.^2,3,5,7 We examined the feasibility of reinforcing the “outside” of the aorta with an external aortic band.^8,9 We report the cases of 5 men and 3 women who underwent EVAR, and in whom adjunctive external aortic banding was used to cinch and reinforce the proximal infrarenal aortic neck to treat or prevent type IA endoleak.     

JOTEC E-vita覆膜支架在胸主动脉腔内治疗中的应用

目的：总结JOTEC E-vita覆膜支架在胸主动脉疾病腔内治疗中的应用经验.方法：自2009年2月至2012年9月,共有70例患者采用JOTEC E-vita覆膜支架行胸主动脉腔内治疗,男性67例,女性3例,年龄32～ 82岁,平均（57.3±10.8）岁.39例为Standford B型主动脉夹层,25例为主动脉穿通性溃疡并壁间血肿,2例为主动脉假性动脉瘤,4例为胸主动脉瘤.65例采用外科切开股动脉置入,5例为完全穿刺下置入.11例因近端锚定区不足覆盖左锁骨下动脉,其中9例采用“烟囱”技术.30例覆膜支架覆盖主动脉的长度＜230mm,定义为A组;40例覆膜支架覆盖主动脉长度≥230mm,定义为B组.术后1,3,6及12个月,之后每年均行主动脉CTA复查,观察有无内漏、病变是否隔绝完全.比较两组围手术期及随访期病死率、内漏发生率及围手术期均无脊髓缺血发生.结果：所有患者均成功的置入覆膜支架,技术成功率100％.除5例置入2枚覆膜支架外,其余均仅置入1枚覆膜支架,共置入75枚覆膜支架.支架锥形头撤除困难2例;支架打折12例;术后即刻内漏17例,内漏发生率为24.3％（17/70）.A、B两组患者围手术期均无脊髓缺血发生.随访2～40个月,随访期间病死率为1.43％ （1/70）,死因为再发Standford A型主动脉夹层.结论：长段胸主动脉病变,尤其是主动脉穿通性溃疡伴（或不伴）壁间血肿,为应用JOTEC E-vita覆膜支架的最佳适应症,并不增加脊髓缺血的发生率.     

Percutaneous Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm

Purpose of Review

This review discusses the benefits of a completely percutaneous approach to endovascular aortic aneurysm repair (EVAR), and provides an outline as to how this is performed by a multidisciplinary team of cardiologists and cardiovascular surgeons at a quaternary care community hospital.

Recent Findings

Percutaneous endovascular aortic aneurysm repair (PEVAR) as compared to EVAR utilizing surgical femoral artery exposure is associated with a significant reduction in operation time, length of stay, access site complications, patient discomfort, and procedural cost. Furthermore, PEVAR may be the preferred approach in patients presenting with aneurysm rupture, as the avoidance of general anesthesia has been associated with improved 30-day mortality.

Summary

Assuming no contraindication based on vascular anatomy, clinical status, or patient preference, these findings suggest that in properly selected patients, PEVAR should be the primary method for abdominal aortic aneurysm repair in both stable and unstable patients.

     

胸主动脉钝性外伤的腔内修复治疗

目的 探讨腔内修复技术在治疗胸主动脉钝性外伤中的可行性和安全性.方法 回顾分析2010年2月至2013年12月期间7例胸主动脉钝性外伤患者的临床资料.术前CTA及术中造影评估病变,回顾术中技术成功率,死亡及截瘫等主要并发症的发生率.术后CTA随访明确有无内漏、支架移位等情况.结果 所有创伤都累及主动脉峡部,包括Stanford B型夹层1例、降主动脉假性动脉瘤6例.全部患者均接受覆膜支架腔内修复治疗,其中1例先行左-右锁骨下动脉转流术.术中6例部分或全部覆盖左锁骨下动脉开口.所有手术患者均获得技术成功,无死亡及截瘫发生.术后随访时间2～28个月,无左上肢缺血症状及神经系统并发症,支架无内漏及移位.结论 腔内修复治疗胸主动脉夹层安全、有效,可行性高.     

Endoluminal stent-graft stabilization for thoracic aortic dissection.

PURPOSE: To review our experience with thoracic endografting for type B aortic dissection using the TAG Endoprosthesis. METHODS: A retrospective analysis was performed of data collected prospectively from March 2000 to July 2004 under an investigational device exemption protocol for the TAG thoracic endograft. In this time period, 40 patients (29 women; mean age 67 years, range 39-91) were treated with this endograft for type B aortic dissection. RESULTS: Technical success was 95%. There was 1 (2.5%) perioperative death, and 1 (3%) endoleak was treated with an additional graft on postoperative day 2. Fifteen (38%) patients experienced postoperative complications, mainly renal or pulmonary, and 1 (3%) patient developed postoperative paraplegia that did not resolve. The 1-year survival was 85%. Follow-up computed tomography was available for 31 patients with an average 15-month follow-up. There was no significant change in size of the thoracic aorta in 22 patients; 8 aneurysmal segments were significantly reduced in size and 1 thoracic aortic aneurysm expanded. No thoracic aortic ruptures were seen in this series. CONCLUSIONS: These early results indicate type B thoracic aortic dissections can be treated with acceptable morbidity and mortality using endografts. Stent-graft repair of the thoracic aorta may decrease the incidence of thoracic aortic expansion and rupture.     

Endoluminal Abdominal Aortic Aneurysm Repair: The Latest Advances in Prevention of Distal Endograft Migration and Type 1 Endoleak

Endovascular abdominal aortic aneurysm repair (EVAR) is an attractive alternative to open surgical repair. Distal endograft migration and type 1 endoleak are recognized to be the 2 main complications of EVAR. First-generation endografts had a stronger propensity for distal migration, modular component separation, thrombosis, and loss of structural integrity. Substantial progress has been made in recent years with 2nd- and 3rd-generation devices to prevent these complications. Some of the most common predictors of endograft failure are angulated and short infrarenal necks, large-diameter necks, and thrombus in the aneurysmal sac. The purpose of this study is to describe and review our experience in using innovative techniques and a newer generation of endografts to prevent distal migration and type 1 endoleak in patients with challenging infrarenal neck anatomy. The use of these innovative EVAR techniques and the new generation of endografts in patients with challenging infrarenal neck anatomy has yielded encouraging procedural and intermediate-term results.Key words: Aneurysm, dissecting; aorta, abdominal; aortic aneurysm; aortic diseases; blood vessel prosthesis implantation; foreign-body migration; prosthesis design; stentsSince Parodi and coworkers performed the 1st endovascular abdominal aortic aneurysm repair (EVAR) in 1990,¹ substantial progress has been made in treating patients with abdominal aortic aneurysms (AAA). Although feasible in the great majority of patients, EVAR can have a high incidence of postprocedural complications in patients who have challenging infrarenal aortic neck anatomy. Some of the more common sequelae include endoleaks, separation of modular components, aneurysm enlargement, stent or hook fractures, and distal migration of the endograft.² One major concern is the potential for migration: the incidence has ranged from 9% to 45%.^3,4 Type 1 endoleak is also one of the dreaded sequelae of EVAR, because there is a potential for aneurysm rupture.     

Relationship between acute kidney injury before thoracic endovascular aneurysm repair and in-hospital outcomes in patients with type B acute aortic dissection

Objective Acute kidney injury (AKI) frequently occurs after catheter-based interventional procedures and increases mortality. However, the implications of AKI before thoracic endovascular aneurysm repair (TEVAR) of type B acute aortic dissection (AAD) remain unclear. This study evaluated the incidence, predictors, and in-hospital outcomes of AKI before TEVAR in patients with type B AAD. Methods Between 2009 and 2013, 76 patients were retrospectively evaluated who received TEVAR for type B AAD within 36 h from symptom onset. The patients were classified into no-AKI vs. AKI groups, and the severity of AKI was further staged according to kidney disease: improving global outcomes criteria before TEVAR. Results The incidence of preoperative AKI was 36.8%. In-hospital complications was significantly higher in patients with preoperative AKI compared with no-AKI (50.0% vs. 4.2%, respectively; P < 0.001), including acute renal failure (21.4% vs. 0, respectively; P < 0.001), and they increased with severity of AKI (P < 0.001). The maximum levels of body temperature and white blood cell count were significantly related to maximum serum creatinine level before TEVAR. Multivariate analysis showed that systolic blood pressure on admission (OR: 1.023; 95% CI: 1.003–1.044; P = 0.0238) and bilateral renal artery involvement (OR: 19.076; 95% CI: 1.914–190.164; P = 0.0120) were strong predictors of preoperative AKI. Conclusions Preoperative AKI frequently occurred in patients with type B AAD, and correlated with higher in-hospital complications and enhanced inflammatory reaction. Systolic blood pressure on admission and bilateral renal artery involvement were major risk factors for AKI before TEVAR.     

Treatment of thoracic aortic disease using endovascular stent-grafts: from therapeutic indications to possible complications

Thoracic endovascular aortic repair (TEVAR) is a minimally invasive technique which is increasingly used in different thoracic aortic pathologies such as aortic aneurysm, complicated type B aortic dissection, aortic trauma, intramural hematoma and penetrating aortic ulcer. In this paper we discuss the main indications for endovascular stent-grafts in the treatment of thoracic aortic disease, based on three cases in which this procedure was used for three different conditions: degenerative aneurysm, complicated type B dissection and post-traumatic injury. These case reports add to the evidence that TEVAR is a safe and feasible therapeutic alternative in selected patients with thoracic aortic disease, improving aortic remodeling, with relatively low morbidity and mortality. The main complications and difficulties related to the procedure are also discussed.     

Myocardial repolarization is affected in patients with ascending aortic aneurysm

Objective

Ascending aortic aneurysm (AAA) is one of the major causes of ventricular diastolic dysfunction. Diastolic dysfunction can induce ventricular repolarization dispersion. Nevertheless, myocardial repolarization dispersion is not yet to be fully evaluated in patients with AAA. We aimed to evaluate ventricular repolarization using QT and Tp-Te interval and corrected (c) Tp-Te/QT ratio in patients with AAA.

“烟囱”技术在胸主动脉夹层腔内修复术中的应用分析

目的 探讨“烟囱”支架技术在近端锚定区长度不足的胸主动脉夹层的主动脉腔内修复术治疗中的应用.方法 回顾性观察2012年8月至2013年9月广东省人民医院17例近端锚定区长度不足的胸主动脉夹层患者使用“烟囱”技术进行主动脉腔内修复术治疗的临床资料.结果 男16例,女1例,Stanford B型主动脉夹层16例,Stanford B型主动脉夹层合并腹主动脉瘤1例.手术成功率为100％,支架释放后即时血管造影显示破口封堵完全,“烟囱”支架血流正常.随访3-16个月,中位时间12个月,无术后死亡患者.随访期间,患者出现左足乏力1例、头晕1例、胸闷痛2例、Ⅰ型内漏2例.无严重神经系统及脏器缺血并发症发生.术后主动脉计算机断层扫描血管造影（CTA）未见移位、明显内漏及“烟囱支架”闭塞等异常.结论 对于近端锚定区长度不足的胸主动脉夹层的患者,使用“烟囱支架技术”进行主动脉腔内修复是安全、有效的治疗方法.     

主动脉支架植入术治疗胸主动脉疾病的效果

目的:探讨胸主动脉疾病支架植入术治疗的适应证和疗效。方法: 对79例胸主动脉疾病行主动脉支架植入的疗效进行回顾性分析。79例患者中,Stanford A型主动脉夹层动脉瘤18例,Stanford B型主动脉夹层动脉瘤49例;主动脉瘤5例;外伤性胸主动脉破裂7例。术前采用CT血管造影(CTA)或磁共振血管造影(MRA)对主动脉进行评估。18例Stanford A型主动脉夹层动脉瘤患者行术中支架置入,其余61例患者在数字减影血管造影(DSA)下经股动脉或髂动脉行支架腔内隔绝术。结果: 内漏8例（10%）,4例于术后3月内自行闭合,1例再次腔内隔绝治疗,3例未进一步治疗;死亡8例（10%）均在术后1月内,其中3例死于神经系统并发症, 4例死于严重的合并症,1例死于主动脉瘤破裂。随访生存3年以上7例（9%）,2年以上14例（18%）,1年以上26例（33%）,1年以内24例(30%)。结论: 主动脉支架植入术可减少手术风险,降低病死率,广泛适用于各种胸主动脉疾病。     

Aortic Dissection and Aortic Aneurysms Associated with Fluoroquinolones: A Systematic Review and Meta-Analysis

Background

Our objective was to evaluate the association between fluoroquinolone use and aortic dissection or aortic aneurysm in a systematic review and meta-analysis.

Aortic dissection after open repair of an infrarenal aortic aneurysm

INTRODUCTION:

A case of thoracic-abdominal dissection after open surgical exclusion of an infrarenal aortic aneurysm is presented.

CASE PRESENTATION:

A 62-year-old woman was diagnosed with an infrarenal abdominal aortic aneurysm with a rapid increase in maximal diameter. She underwent surgery for aneurysm exclusion by an end-to-end aortoaortic bypass with Dacron collagen (Intervascular; WL Gore & Associates Inc, USA). After 15 days, she was admitted to the emergency department with intense epigastric and lumbar pain. Computed tomography angiography with contrast revealed an aortic dissection with origin in the proximal bypass anastomosis and cranial extension to the thoracic aorta. The true lumen at the level of the eighth thoracic vertebra was practically collapsed by the false lumen. The celiac trunk, and the mesenteric and renal arteries were perfused by the true lumen. After the acute phase of the aortic dissection, surgical repair was planned. Two paths of false lumen were found – one at the thoracic aorta and the second in the proximal bypass anastomosis. Surgical repair comprised two approaches. First, a Valiant Thoracic stent graft (Medtronic Inc, UK) was implanted distal from the left subclavian artery, expanding the collapsed true lumen and covering the false and dissected lumen. Second, an infrarenal Endurant abdominal stent graft (Medtronic Inc) was implanted. This second device was complemented with an aortic infrarenal extension using a Talent abdominal stent graft (Medtronic Inc) in the infrarenal aortic neck to achieve a hermetic seal. The postoperative clinical course was uneventful, and her symptoms were completely resolved in six months.

CONCLUSION:

Arteritis must be taken into account in young patients with high inflammatory markers. Covered stents and endoprosthetic devices seem to be effective methods to seal the dissected lumen.     

A hybrid therapy as a third approach for type 1 proximal endoleak of thoracic endovascular aortic replacement: Caroticocarotid bypass and re-redo endovascular therapy

IntroductionIn selected cases with thoracic aortic aneurysm (TAA), thoracic endovascular aortic replacement (TEVAR) is commonly used and shall be proper therapy method. We are presenting a case of TAA previously treated twice by endovascular aortic approaches and complicated by type 1 endoleak.CaseA 67-year-old male patient was admitted to our clinic with back pain at rest. He underwent TEVAR five years ago, twice in 6 month. With contrasted computed tomography of chest and abdomen, a new type 1 proximal endoleak was diagnosed, and after routine preoperative follow up, the patient was operated on. At the same session right to left caroticocarotid bypass and re-redo TEVAR were performed. The new endovascular graft was placed as the proximal landing zone to be set between left carotid artery and brachiocephalic truncus. The patient was discharged on postoperative day 4 without any problems.ConclusionAs new techniques and methods have been developed, mortality rates have decreased to 2–3% but in older and high risk patients, mortality rates still remain high [1]. TEVAR is a safe and effective treatment method in the proper and selected patients with thoracic artery aneurysm [2]. Moreover, TEVAR can also be performed as a part of hybrid procedures for arcus aortic aneurysms [3]. But it should be kept in mind that late secondary intervention rates are higher in TEVAR.     

Acute aortic dissection: Epidemiology and outcomes

Background

Little epidemiological information on acute aortic dissection (AAD) is available in the literature. The objective of the present study was to determine the incidence and mortality rates of AAD in the general population and to analyze its clinical features.

Methods

Data from the Emilia-Romagna regional database of hospital admissions was analyzed. Urgent admissions with the diagnosis of dissection of the aorta, dissection of the thoracic aorta and dissection of the thoracoabdominal aorta were selected.

Results

Between January 2000 and December 2008, 1499 Emilia-Romagna residents were hospitalized with a diagnosis of AAD. The patients were divided into three groups: Group A, 617 patients (41.2%) surgically treated for type A AAD; Group B, 93 complicated patients (6.2%) with type B AAD treated by endovascular stent-grafting and Group C, 789 patients (52.6%) suffering from any type of AAD medically treated. The overall annual incidence rate was 4.7%/100,000 people and was higher for men than for women (6.7% vs 2.9%).Two hundred ninety-six patients (19.8%) were 80 years of age or older.The overall in-hospital mortality rate was 27.7%, with mortality rates of 21.1%, 26.9% and 33% in Groups A, B and C, respectively.

Conclusion

The incidence of AAD is not negligible and a notable rate of patients is ultra-octogenarian. A large number of patients with AAD had no surgery or interventional treatment. The results of surgical treatment for patients with type A dissection are acceptable but the results obtained in patients with complicated type B dissection who were treated with an endoprosthesis are dismal.