SEARCH · PubMed Health

Results for “Dissection”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources

PubMed1992

Therapeutic dissection after successful coronary balloon angioplasty: no influence on restenosis or on clinical outcome in 693 patients. The MERCATOR Study Group (Multicenter European Research Trial with Cilazapril after Angioplasty to prevent Transluminal Coronary Obstruction and Restenosis).

OBJECTIVES: The objective of this study was to examine the relation between an angiographically visible coronary dissection immediately after successful coronary balloon angioplasty and a subsequent restenosis and long-term clinical outcome. BACKGROUND: The study population comprised all 693 patients who participated in the MERCATOR trial (randomized, double-blind, placebo-controlled restenosis prevention trial of cilazapril, 5 mg two times a day). METHODS: Cineangiographic films were processed and analyzed at a central angiographic core laboratory, without knowledge of clinical data, with use of an automated interpolated edge detection technique. Dissection was judged according to the National Heart, Lung, and Blood Institute classification. Angiographic follow-up was obtained in 94% of patients with 778 lesions. Two approaches were used to assess the restenosis phenomenon: 1) categoric, using the traditional cutoff criterion of greater than 50% diameter stenosis at follow-up, and 2) continuous, defined as absolute change in minimal lumen diameter (mm) between the postcoronary angioplasty and follow-up, adjusted for the vessel size (relative loss). Clinical outcome was ranked according to the most serious adverse clinical event per patient during the 6-month follow-up period, ranging from death, nonfatal myocardial infarction, coronary revascularization and recurrent angina requiring medical therapy to none of these. RESULTS: Dissection was present in 247 (32%) of the 778 dilated lesions. The restenosis rate was 29% in lesions with and 30% in lesions without dissection (relative risk 0.97; 95% confidence interval 0.77 to 1.23). The relative loss in both groups was 0.10 (mean difference 0; 95% confidence interval -0.03 to 0.03). Clinical outcome ranged from death in 4 patients (0.9%) without dissection and 1 patient (0.4%) with dissection; nonfatal myocardial infarction in 4 (0.9%) without and 8 (3.2%) with dissection; coronary revascularization in 73 (16.6%) without and 32 (12.7%) with dissection; recurrent angina requiring medical therapy in 88 (20%) without and 47 (18.7%) with dissection to no serious adverse event in 272 (61.7%) without and 114 (65.1%) with dissection. CONCLUSIONS: These data indicate that a successfully dilated coronary lesion with an angiographically visible dissection is no more likely to develop restenosis, and is not associated with a worse clinical outcome, at 6-month follow-up than is a dilated lesion without visible dissection on the post-balloon angioplasty angiogram.

Angioplasty, Balloon, Coronary↗

PubMed1994

[Mediastinal lymph node dissection improves survival rate in N2(-) non-small cell lung cancer patients].

The effect of mediastinal lymph node dissection on survival rate in clinical N2(-) non-small cell lung cancer patients was assessed. N2(-) was evaluated by both pre-operative computed tomography studies and physical examination during surgery. Systematic mediastinal lymph node dissection, including nodes #1, 2, 3, 3a, 3p, 4, 7, 8 and 9 was performed in 27 patients (T1 or 2, N0 or 1, M0) since 1987 (dissected group). Survival rate and complications were compared with those in 21 patients treated before 1986, in whom mediastinal lymph nodes were not dissected (non-dissected group). 1, 3 and 5 year survival rates in the dissected group were 92.6%, 74.9%, and 74.9%, respectively, which were significantly higher than those in the non-dissected group (71.4%, 61.9% and 41.3%, respectively). Mediastinal lymph node metastases were detected histologically found in three patients, 11% of the dissected group. Respiratory complications showed a significantly higher incidence in the dissected group (p = 0.001). However these complications did not increase the mortality rate in that group. Among elderly patients over 70 years old (8 patients in the dissected group, 7 in the non-dissected group), survival rates were similar in the two groups. In conclusion, systematic mediastinal lymph node dissection significantly improved the survival rate in clinical N2(-) non-small cell lung cancer patients.

Aged↗

PubMed1997

Neck dissection for surgical treatment of lymphnode metastasis in papillary thyroid carcinoma.

In papillary thyroid carcinoma lymphnode metastases at presentation do not seem to adversely affect survival, but do increase the risk of loco-regional tumor recurrence. The value of systematic versus selective lymphadenectomy is far less standardized, whereas the role of postoperative radioiodine in preventing either nodal recurrence or cancer death remains controversial. Clinical data of 36 N+ patients with papillary thyroid carcinoma who had undergone from 1990 to 1996 ipsilateral or bilateral neck dissection were retrospectively reviewed, to analyse the value of systematic lymphadenectomy. In our series of 50 extensive lymph node dissections (levels 2-6), the number of metastases in each specimen (mean value: 5) and the incidence of multiple level metastases (36%) were high. In 37.5% of the metastases at level 6 and in 11.1% at level 4, coexisting nodal involvement at level 2 was observed, without metastasization at intermediate levels. Multiple levels metastases and skip metastases were present in at least one third of the patients and could be excised only performing a complete dissection of the levels 2-6. Extra-capsular spread was found in 56% of the specimens. In 64.3% of these cases a functional neck dissection was performed. A modified radical or radical neck dissection was carried out in the other 35.7% of the cases. These patients received modified radical neck dissection (functional dissection with sacrifice of internal jugular vein) in 60% of the cases and radical neck dissection in the other 40%. In papillary thyroid carcinoma extensive lymphnode dissection at presentation has been stated to offer no advantage versus selective lymphadenectomy, causing increased morbidity. However, experienced surgeons report a low incidence (less than 5%) of accessory spinal nerve and cervical plexus permanent sequelae after functional neck dissection. In our opinion, patients with cervical lymph node metastases require a complete loco-regional neck dissection. Systematic lymphadenectomy, performed by lateral neck plus upper anterior mediastinal dissection, can yield a high disease-free survival. Moreover, this can limit the overall radio-iodine therapeutic dose and the risk of de-differentiation of recurrent tumor to the anaplastic type in patients with a long-term and near normal life-span.

Adult↗

PubMed1997

Expanded application of selective neck dissection with regard to nodal status.

BACKGROUND: The efficacy of extending the application of selective neck dissection to include more-extensive neck disease in patients with squamous carcinoma of the upper aerodigestive tract remains controversial. METHODS: A review of all patients undergoing selective neck dissection at a single institution during a 5-year period was undertaken. The analysis was conducted on 82 patients who received 94 selective neck dissections as part of initial therapy for management of squamous carcinoma of the upper aerodigestive tract, including: oral cavity, oropharynx, larynx, and hypopharynx. RESULTS: Forty-six of the 94 dissected necks were supraomohyoid dissections, and 48 were lateral neck dissections. Sixty-five percent of patients were followed a minimum of 2 years and formed the cohort for final analysis. There were eight regional recurrences, three of which occurred in the contralateral, undissected neck. The regional recurrence rate for all patients undergoing selective neck dissection, with or without radiotherapy, according to pathologic N status was as follows: NO (1/33), 3%; N1 (1/8), 12.5%; and multiple positive nodes (3/26), 11.5%. A comparison of recurrence rates with respect to extent of neck disease (N0-N1 versus multiple positive nodes) for both types of neck dissection did not demonstrate significant differences; supraomohyoid neck dissection, p < .5; lateral neck dissection, p < .25. CONCLUSIONS: There exists an expanded role for selective neck dissection in selected patients with primary squamous cell carcinoma of the upper aerodigestive tract and multiple N+ cervical disease. The selection of patients who are candidates for selective lymphadenectomy should be based on pathoanatomic considerations with reference to the primary site of tumor and demonstrated level(s) of metastatic involvement.

Aged↗

PubMed1995

Coronary artery disease in patients with type A aortic dissection.

The usefulness of preoperative coronary arteriography in patients with type A dissection of the aorta is controversial. To determine the prevalence of arteriosclerotic coronary artery disease in patients with type A dissection of the aorta, we reviewed our experience in 62 patients (42 with acute dissection and 20 with chronic dissection) who underwent operation between January 1, 1986, and December 31, 1993. Among 23 patients with acute dissection who underwent coronary arteriography, 8 (34.8%) had one or more coronary artery lesions causing a greater than 50% narrowing. Among 14 patients with chronic dissection who underwent coronary arteriography, 6 (42.9%) had one or more coronary artery lesions causing a greater than 50% narrowing. There were no fatal complications associated with coronary arteriography. Four patients with acute dissection and 6 patients with chronic dissection underwent coronary artery bypass grafting at the time of operative repair of the aortic dissection, with no operative deaths. On the basis of these findings and the success of combined coronary artery bypass grafting and aortic repair, we recommend that patients with an acute type A dissection who are in stable condition and all patients with a chronic type A dissection of the aorta should undergo preoperative coronary arteriography.

Acute Disease↗

PubMed1997

Angiographic evolution of intracoronary thrombus and dissection following percutaneous transluminal coronary angioplasty (the Thrombolysis and Angioplasty in Unstable Angina [TAUSA] trial).

The evolution and progression of thrombus and dissection after percutaneous transluminal coronary angioplasty (PTCA) are unknown. As part of the protocol of the Thrombolysis and Angioplasty in Unstable Angina (TAUSA) trial, 1 and 15 minutes post-PTCA angiograms were routinely performed and evaluated by the core laboratory for the presence of thrombus and either minor or major dissection. Thrombus was present at 1 minute in 4.4% of culprit lesions. This increased to 16% at 15 minutes (p < 0.005) and was equally seen in patients receiving both urokinase and placebo. Any dissection was noted in 25.2% at 1 minute versus 30.5% at 15 minutes (p < 0.08), and this trend was mainly related to an increase in major dissection with urokinase at 15 minutes versus 1 minute (10.1% vs 5.9%, respectively, p = 0.10). The in-hospital clinical outcome of patients with lesions that did or did not have thrombus or major dissection at 1 and 15 minutes was retrospectively assessed in the placebo group. The presence of either thrombus or major dissection at 1 minute was associated with a subsequent incidence of acute closure of 14% and an incidence of emergency bypass surgery of 11% (p < 0.01 compared with no thrombus or major dissection at 1 minute). The absence of thrombus and major dissection at 15 minutes (n = 173) was associated with no subsequent acute closure or emergency bypass surgery, (p < 0.05 for acute closure vs thrombus or major dissection at 15 minutes). Thrombus evolves progressively over 15 minutes after PTCA in unstable angina, whereas dissection is usually present immediately after PTCA. The absence of thrombus and major dissection at 15 minutes is associated with very low-acute in-hospital complications. Delayed angiograms following standard balloon angioplasty for unstable angina may be predictive of low complications and our study suggests a possible role for their use.

Acute Disease↗

PubMed1994

Classification of neck dissection: variations on a new theme.

BACKGROUND: Commencing in 1984, we initiated a head and neck service surgical database that included a classification system for neck dissection. The aim was to reduce the confusion in terminology resulting from growing interest in modifications of conventional radical neck dissection. METHODS: We considered a neck dissection as radical when four or five lymph node levels were excised; this included patients who had an otherwise classical neck dissection for supraglottic larynx or hypopharyngeal cancer sparing level 1. Lymph-node levels removed, nonlymphatic structures preserved, and excised nonlymphatic structures not ordinarily included in a classical radical neck dissection were all specified by the operating surgeon. We defined as a selective neck dissection any lymphadenectomy that encompassed no more than three nodal levels, usually supraomohyoid (levels 1, 2, 3), or jugular (levels 2, 3, 4). We defined as a limited neck dissection any lymphadenectomy that involved removal of no more than two nodal levels. RESULTS: At the 10-year mark, this database of 10,650 patients now includes 2,635 lymphadenectomies in 2,426 patients, the precise extent of which is accurately described in each patient. CONCLUSIONS: The current classification of neck dissection does not cover all possibilities. If we define as radical those lymphadenectomies that resect four or five nodal levels and specify structures preserved or additional nonlymphatic structures sacrificed, we allow for the possibility that some procedures may be both modified and extended. Selective would describe the standard, three-level dissections (eg, supraomohyoid or jugular node dissections), and the term limited would be introduced to indicate a neck dissection that involves removal of no more than two nodal levels. Such a three-tiered classification would more accurately reflect the time and effort involved and provide a more equitable basis for reimbursement.

Carcinoma, Squamous Cell↗

PubMed1996

Detecting acute thoracic aortic dissection in the emergency department: time constraints and choice of the optimal diagnostic test.

STUDY OBJECTIVES: To compare diagnostic strategies for the emergency assessment of patients with suspected acute thoracic aortic dissection and to measure the effect of delays related to the availability of these tests on the selection of the most appropriate one. METHODS: We carried out a decision analysis representing the risks of performing one or two sequential tests, the tests' accuracy, the risks and benefits of treatment, and the time-dependent mortality rate in untreated patients with dissection (1%/hour). Data were drawn from a Medline search. Our subjects were patients who presented to the emergency department with chest pain in whom acute thoracic aortic dissection was suspected. For different clinical probabilities of aortic dissection, we compared the risks and benefits of testing using the following procedures (alone and in combinations): aortography, computed tomography (CT), magnetic resonance imaging (MRI), and both transesophageal (TEE) and transthoracic echocardiography (TTE). We then measured the effect of delays in these tests on the selection of the appropriate procedure. The outcome studied was 30-day survival. RESULTS: We determined that the "threshold" clinical probability of aortic dissection above which the benefits of testing outweigh its risks is low. It ranges from 2% with the most reliable procedure (MRI) to 9% with the least (TTE). At low probability of dissection (< 15%), the accuracy of all tests except TTE is sufficient to rule out dissection. Delays have negligible effect on these results. When the likelihood of dissection is higher, the preferred option is to order a second diagnostic test if the results of the first are negative. The threshold probabilities above which to order a second test range from 15% (CT, then aortography) to 35% (MRI, then aortography). Excessive delays may affect the selection of tests when the likelihood of dissection is high (eg, 50%). Thus, although it is less accurate, a CT scan obtained within 2 hours or a TEE obtained within 6 hours of presentation to the ED yields a higher survival rate than an MRI obtained within 9 hours. Similarly, the benefits of ordering a second test, if the result of the first are negative, outweigh the risks only if the delay in obtaining the test does not exceed 10 hours. CONCLUSION: All patients in whom aortic dissection is suspected, even if the index of suspicion is very low, should undergo one of the available diagnostic procedures (except TTE). A patient with a moderate to high probability of disease should undergo a second investigation if the findings of the first are negative. When the probability of dissection is high, the physician must consider delays in obtaining specific diagnostic tests and order those that will be the most quickly available.

Aortic Dissection↗

PubMedDate not supplied

Use of a balloon-expandable intravascular graft in the management of type B aortic dissection in an animal model.

PURPOSE: To evaluate obliteration of an experimental aortic dissection with a balloon-expandable intravascular stent. MATERIALS AND METHODS: Fourteen adult dogs were divided into two groups. In group 1 (n = 6), a thoracoabdominal aortic dissection was surgically created to observe the natural course of this lesion. In group 2 (n = 8), a balloon-expandable intraluminal vascular graft was introduced via the femoral artery in a dissected aorta to try to obliterate the dissection. Angiography was performed postoperatively and again 6 weeks later before the aortae were explanted for pathologic evaluation. RESULTS: In group 1, postoperative aortography depicted evidence of aortic dissection in all animals. Autopsy revealed persisting dissection with reentry tear near the celiac axis in five animals. In group 2, placement of a stent at only entry and reentry sites resulted in partial obliteration of the dissection (n = 3). When the entire length of dissected aorta was treated, the dissection was completely obliterated (n = 4). CONCLUSION: An aortic dissection can be obliterated with a balloon-expandable stent if the entire dissected aorta is treated.

Aortic Dissection↗

PubMed1994

[Surgically treated thoracic aortic dissection. The angiographic follow-up of the perfusion relations].

Control angiography in arterial DSA technique was performed in 27 patients after operative treatment of acute aortic dissection (17 patients with type A dissection) respectively chronic aortic dissection (9 patients with type A dissection/1 patient with type B dissection). The mean interval between surgery and angiography was 59 months. All patients were free from symptoms due to organ complications or redissection. Persistent patency of a false lumen was observed in 40.7% (52.9% after operative treatment of an acute dissection; 20% after operative treatment of a chronic dissection). In all cases with a persistent false lumen the dissection originated at the distal anastomosis. In all patients the beginning of the dissection and the perfusion of the supra-aortal, visceral and iliac vessels whether by the true or false lumen could be shown. In 54.5% the Tr. brachiocephalic trunk was involved in the dissection. In 45.5% the left renal artery was solely perfused by the false lumen. Angiography in arterial DSA technique is evidently a valuable technique to document the beginning and extension of a dissection, sufficiency of the aortic valve, re-entries of the dissection, perfusion of the aortal branches, and the flow in both channels.

Acute Disease↗

PubMed1976

Observations on the treatment of dissection of the aorta.

The results are presented of treatment in twenty-three patients with dissection of the thoracic aorta, in four of whom it was acute (less than 14 days' duration), and in nineteen chronic (more than 14 days' duration). Sixteen patients had Type I and II dissection (involving the ascending aorta) and five Type III (descending aorta at or distal to the origin of the left subclavian artery); in two, dissection complicated coarctation of the aorta in the usual site. Thirteen patients had aortic regurgitation. Three of the patients with acute dissection were treated medically; two, both with Type I dissection, died, and the third, with Type III, survived. The remaining acute patient was treated surgically and also died. Of the patients with chronic dissection, eight were treated medically and eleven surgically. None of the medical group died in hospital; three died between 3 months and 1 year, and five have survived from periods of 12-72 months. Eleven patients with chronic dissection were treated surgically; four died in hospital at or shortly after operation; and the remaining seven lived for periods of 12-84 months. The presentation, indications for surgical treatment and results are discussed. It is concluded that surgical treatment of chronic dissection may carry a higher initial mortality than medical, but that there may be slightly better overall long term results in the former. As this series was not selected randomly, because patients with complications were selected for surgery, and there are only a few patients in each group, the results do not permit firm conclusion regarding the relative merits of medical and surgical treatment. It is suggested that all patients should initially be treated medically but that surgical treatment should be considered if the dissection continues, if aortic regurgitation is severe, if an aneurysm develops or enlarges, if cardiac tamponade develops or there is evidence of progressive involvement of the branches of the aorta. Attention is drawn to the important syndrome of chronic dissecting aneurysm of the ascending aorta with severe aortic regurgitation which requires definitive surgical treatment and aortic valve replacement. The importance of adequate visualization of the origin and extent of the dissection as a preliminary to surgical treatment is stressed.

Acute Disease↗

PubMed1996

Recurrent spontaneous arterial dissections: risk in familial versus nonfamilial disease.

BACKGROUND AND PURPOSE: Among patients with spontaneous cervical artery dissections, the risk of recurrent arterial dissection is relatively low at 1% per year, but this risk may be higher for patients with a family history of arterial dissections. We compared the risk of a recurrent arterial dissection in patients with familial versus non familial disease. METHODS: Long-term follow-up was established in 200 patients (104 women and 96 men with a mean age of 44.9 years) with spontaneous cervical artery dissections evaluated at a single institution between 1970 and 1990. RESULTS: Among the 200 patients, 10 (5%) were identified who had a family history of spontaneous arterial dissections. In a multivariate analysis, family history was the only significant variable associated with the risk of recurrent dissection (X2=15.51; P=.0001). A recurrent arterial dissection was identified in 5 (50%) of the 10 patients with familial disease compared with 11 (5.8%) of the 190 patients with nonfamilial disease, with an estimated relative risk of 6.3 (95% confidence interval, 2.2 to 18.3; P=.0007). CONCLUSIONS: Among patients with spontaneous cervical artery dissections, a family history of arterial dissection is an important risk factor for the development of a recurrent arterial dissection.

Adolescent↗

PubMed1984

Functional neck dissection: an evaluation and review of 843 cases.

After briefly reviewing the principles, indications, and merits of functional neck dissection, the results of 1200 neck dissections performed on 843 patients in the period 1961-1979 are presented. They compare very favorably with those reported for classic (radical) neck dissection by other leading authors; however, a retrospective analysis of data derived from material of different origin is hardly possible and has a disputable value. Therefore, we decided to compare our data on functional neck dissections (FND) with those of classic neck dissections (CND) performed by the same surgical team at the same clinic in the period 1948-1960. The clinical material was largely the same in both cases, and the data were collected and analyzed using the same criteria. In both series, neck dissections were divided into elective and curative. It could be demonstrated that the number of neck recurrences observed in the dissected necks is the same for FND and CND in curative dissections, while it is considerably lower for FND in elective neck dissections. This of course does not prove improved radicality in FND, but only proves that a systematic bilateral elective neck dissection in N0 cases affords improved cancerological safety. This radical bilateral approach to regional lymph nodes is made possible routinely by FND which avoids the problems of unnecessary mutilation. The figures produced speak in favor of a wider adoption of FND especially for expanding the indications to elective treatment of regional lymph nodes in cancer of the head and neck. Elective neck dissection is made practically harmless by this newer technique and averts the dreadful appearance of late metastases in N0 cases.

Head and Neck Neoplasms↗

PubMed1993

Endovascular treatment of vertebral artery dissections and pseudoaneurysms.

Sixteen patients with dissecting aneurysms or pseudoaneurysms of the vertebral artery, 12 involving the intradural vertebral artery and four occurring in the extradural segment, were treated by endovascular occlusion of the dissection site. Patients with vertebral fistulas were excluded from this study. The dissection was caused by trauma in three patients (two iatrogenic) and in the remaining 13 no obvious etiology was disclosed. Nine patients presented with subarachnoid hemorrhage (SAH), two of whom had severe cardiac disturbances secondary to the bleed. The nontraumatic dissections occurred in seven women and six men, with a mean age on discovery of 48 years. Fifteen patients were treated with endovascular occlusion of the parent artery at or just proximal to the dissection site. One patient had occlusion of a traumatic pseudoaneurysm with preservation of the parent artery. Four patients required transluminal angioplasty because of severe vasospasm produced by the presenting hemorrhage, and all benefited from this procedure with improved arterial flow documented by transcranial Doppler ultrasonography and arteriography. In 15 patients angiography disclosed complete cure of the dissection. One patient with a long dissection of extracranial origin extending intracranially had proximal occlusion of the dissection site. Follow-up angiography demonstrated healing of the vertebral artery dissection but persistent filling of the artery above the balloons, which underscores the need for embolic occlusion near the dissection site. No hemorrhages recurred. One patient had a second SAH at the time of therapy which was immediately controlled with balloons and coils. This patient and one other had minor neurological worsening resulting from the procedure (mild Wallenberg syndrome in one and minor ataxia in the second). Symptomatic vertebral artery dissections involving the intradural and extradural segments can be effectively managed by endovascular techniques. Balloon test occlusion and transluminal angioplasty can be useful adjuncts in the management of this disease.

Adult↗

PubMed1991

Aortic dissection resulting from tear of transverse arch: is concomitant arch repair warranted?

Forty-seven patients with aortic dissection resulting from a primary tear located in the transverse aortic arch underwent surgical treatment. Twenty-six patients had acute type A, 7 had acute type B, 7 had chronic type A, and 7 had chronic type B aortic dissections. Of the 33 patients with acute dissections, 11 (7 acute type A and 4 acute type B) underwent concomitant arch repair with an operative (less than or equal to 30 days) mortality rate of 55% (35% to 73%, +/- 1 asymmetric 70% confidence limit) (2 of 7 acute type A and 4 of 4 acute type B). Concomitant arch repair was omitted in 22 patients with acute dissections (19 acute type A and 3 acute type B); the operative mortality rate was 41% (29% to 54%) (7 of 19 acute type A and 2 of 3 acute type B) (p = not significant versus arch repair). The overall survival rate for those with arch repair was 45% +/- 15% (+/- 1 standard error of the estimate) at 4 years, compared with 43% +/- 11% for patients without arch repair (p = not significant). Considering the type of dissection, the 4-year survival estimate for patients with acute type A dissections who underwent arch repair (5 hemiarch and 2 total arch) was 71% +/- 17% (versus 44% +/- 12% for acute type A patients without arch repair). There were no survivors among the 4 patients with acute type B dissections who had an arch repair (1 hemiarch and 3 total arch), whereas patients with acute type B dissections who did not undergo concomitant arch repair had a 4-year survival estimate of 33% +/- 27% (p = not significant versus arch repair). Four other patients with acute type B dissections resulting from an arch tear were managed medically and tended to have a slightly better prognosis (2-year survival estimate of 75% +/- 22% versus 14% +/- 13% for all surgically treated acute type B patients), but again this difference was not statistically significant. Multivariate analysis of the 47 surgical patients revealed that advanced age (p = 0.0008), preoperative dissection complications (p = 0.02), and other coexistent medical problems (p = 0.03) were the only significant, independent determinants of overall mortality. Initial arch repair was not a significant predictor. Nine percent (2/22) of patients with acute type A dissections who initially underwent isolated ascending aortic replacement required subsequent arch replacement; 1 died after reoperation.(ABSTRACT TRUNCATED AT 400 WORDS)

Actuarial Analysis↗

PubMed1991

Prognosis of patients with medically treated aortic dissections.

The purpose of this study is to evaluate the long-term results of medical treatment for a dissecting aorta and to detect the risk factors that determine the prognosis of medically treated patients. During the past 10 years, 228 patients with aortic dissections were admitted to our hospital and affiliated hospitals. One hundred thirty-four patients, including 60 with proximal type (Stanford, type A) and 74 with peripheral type (Stanford, type B) dissections, were treated by medical means alone. The survival rates of medically treated patients with type A dissections at 24 hours, 2 weeks, and 5 and 10 years after the onset of the disease were 72, 43, 34, and 28%, respectively, and the survival rates in type B dissections were 100, 92, 76, and 56%, respectively. The risk factors that determine poor prognosis in the acute phase of dissections were type A dissection and serious complications (rupture of the aorta, shock, cerebral accident, myocardial infarction, severe aortic regurgitation, renal failure, mesenteric infarction, and arterial occlusion in the extremities). The risk factors in the chronic phase were serious complications, excluding shock and rupture in the acute phase, the large diameter of the dissecting aorta, and increasing age. These results show that emergency surgical intervention is indicated in the patients with acute type A dissections and in those who had acute type B dissections with these serious complications. Medical treatment may be tentatively recommended for the patients with uncomplicated type B dissections until the operative death rate in these patients becomes less than presently identified.

Aortic Dissection↗

PubMed1989

[Experimental study on the dissecting aortic aneurysm].

Type I dissecting aortic aneurysm is not only the most common type of all but an extremely lethal event. It is important to create the experimental model of type I dissection for clarifying behavior of this disease and successful treatment. The purpose of this study is: (1) production of experimental model of type I aortic dissection; (2) examination of progression manner of dissection; (3) and investigation of influence of dissection upon aortic valve and coronary artery. The experimental model of type I aortic dissection was produced in adult mongrel dogs. Bilateral thoracotomy was made and intimal tear was created in the ascending aorta by modified Blanton's procedure. Hypertension and creation of large pocket of the aortic media were necessary to produce type I aortic dissection. Extension of dissection had a tendency toward the inner layer of the aortic wall at distal site. However, at proximal site the dissection progressed in the same layer of the aortic wall. In this series, retrograde extension of dissection remained blind above annulus of aortic valve, and no incidence of aortic regurgitation or coronary ischemia was occurred. But on histologic examination, degeneration of the aortic wall by the dissection was observed. Such weakness of aortic wall showed potentiality to developed into subsequent aortic regurgitation or coronary ischemia.

Aged↗

PubMed1994

Intracranial vertebral artery dissection in Wallenberg syndrome.

PURPOSE: To assess the prevalence of vertebral artery dissection in Wallenberg syndrome. METHODS: Sixteen patients (12 men, 4 women; mean age at ictus, 51.6 years) with symptoms of Wallenberg syndrome and an infarction demonstrated in the lateral medulla on MR were reviewed retrospectively. The study items were as follows: (a) headache as clinical signs, in particular, occipitalgia and/or posterior neck pain at ictus; (b) MR findings, such as intramural hematoma on T1-weighted images, intimal flap on T2-weighted images, and double lumen on three-dimensional spoiled gradient-recalled acquisition in a steady state with gadopentetate dimeglumine; (c) direct angiographic findings of dissection, such as double lumen, intimal flap, and resolution of stenosis on follow-up angiography; and (d) indirect angiographic findings of dissection (such as string sign, pearl and string sign, tapered narrowing, etc). Patients were classified as definite dissection if they had reliable MR findings (ie, intramural hematoma, intimal flap, and enhancement of wall and septum) and/or direct angiographic findings; as probable dissection if they showed both headache and suspected findings (ie, double lumen on 3-D spoiled gradient-recalled acquisition in a steady state or indirect angiographic findings); and as suspected dissection in those with only headache or suspected findings. RESULTS: Seven of 16 patients were classified as definite dissection, 3 as probable dissection, and 3 as suspected dissection. Four patients were considered to have bilateral vertebral artery dissection on the basis of MR findings. CONCLUSIONS: Vertebral artery dissection is an important cause of Wallenberg syndrome.

Adult↗