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Clinical outcomes of endovascular treatment for ruptured thoracic aortic disease

BACKGROUND/AIMS: Untreated rupture of the thoracic aorta is associated with a high mortality rate. We aimed to review the clinical results of endovascular treatment for ruptured thoracic aortic disease. METHODS: We retrospectively reviewed data on 37 patients (mean age, 67.0 ± 15.18 years) treated f...

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Autores principales: Choi, Jong Hyun, Kim, Sang-Pil, Lee, Han Cheol, Park, Tae Sik, Park, Jong Ha, Kim, Bo Won, Ahn, Jinhee, Park, Jin Sup, Lee, Hye Won, Oh, Jun-Hyok, Choi, Jung Hyun, Cha, Kwang Soo, Hong, Taek Jong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Association of Internal Medicine 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009169/
https://www.ncbi.nlm.nih.gov/pubmed/32264656
http://dx.doi.org/10.3904/kjim.2019.080
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author Choi, Jong Hyun
Kim, Sang-Pil
Lee, Han Cheol
Park, Tae Sik
Park, Jong Ha
Kim, Bo Won
Ahn, Jinhee
Park, Jin Sup
Lee, Hye Won
Oh, Jun-Hyok
Choi, Jung Hyun
Cha, Kwang Soo
Hong, Taek Jong
author_facet Choi, Jong Hyun
Kim, Sang-Pil
Lee, Han Cheol
Park, Tae Sik
Park, Jong Ha
Kim, Bo Won
Ahn, Jinhee
Park, Jin Sup
Lee, Hye Won
Oh, Jun-Hyok
Choi, Jung Hyun
Cha, Kwang Soo
Hong, Taek Jong
author_sort Choi, Jong Hyun
collection PubMed
description BACKGROUND/AIMS: Untreated rupture of the thoracic aorta is associated with a high mortality rate. We aimed to review the clinical results of endovascular treatment for ruptured thoracic aortic disease. METHODS: We retrospectively reviewed data on 37 patients (mean age, 67.0 ± 15.18 years) treated for ruptured thoracic aortic disease from January 2005 to May 2016. The median follow-up duration was 308 days (interquartile range, 61 to 1,036.5). The primary end-point of the study was the composite of death, secondary intervention, endoleak, and major stroke/paraplegia after endovascular treatment. RESULTS: The etiologies of ruptured thoracic aortic disease were aortic dissection (n = 11, 29.7%), intramural hematoma (n = 7, 18.9%), thoracic aortic aneurysm (n = 14, 37.8%), and traumatic aortic transection (n = 5, 13.5%). Three patients died within 24 hours of thoracic endovascular aortic repair, and one showed type I endoleak. The technical success rate was 89.2% (33/37). The in-hospital mortality rate was 13.5% (5/37); no deaths occurred during follow-up. The composite outcome rate during follow-up was 37.8% (14/37), comprising death (n = 5, 13.5%), secondary intervention (n = 5, 13.5%), endoleak (n = 5, 13.5%), and major stroke/paraplegia (n = 3, 8.1%). Left subclavian artery revascularization and proximal landing zone were not associated with the composite outcome. Low mean arterial pressure (MAP; ≤ 60 mmHg, [hazard ratio, 13.018; 95% confidence interval, 2.435 to 69.583, p = 0.003]) was the most significant predictor and high transfusion requirement in the first 24 hours was associated with event-free survival (log rank p = 0.018). CONCLUSIONS: Endovascular treatment achieves high technical success rates and acceptable clinical outcome. High transfusion volume and low MAP were associated with poor clinical outcomes.
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spelling pubmed-80091692021-04-02 Clinical outcomes of endovascular treatment for ruptured thoracic aortic disease Choi, Jong Hyun Kim, Sang-Pil Lee, Han Cheol Park, Tae Sik Park, Jong Ha Kim, Bo Won Ahn, Jinhee Park, Jin Sup Lee, Hye Won Oh, Jun-Hyok Choi, Jung Hyun Cha, Kwang Soo Hong, Taek Jong Korean J Intern Med Original Article BACKGROUND/AIMS: Untreated rupture of the thoracic aorta is associated with a high mortality rate. We aimed to review the clinical results of endovascular treatment for ruptured thoracic aortic disease. METHODS: We retrospectively reviewed data on 37 patients (mean age, 67.0 ± 15.18 years) treated for ruptured thoracic aortic disease from January 2005 to May 2016. The median follow-up duration was 308 days (interquartile range, 61 to 1,036.5). The primary end-point of the study was the composite of death, secondary intervention, endoleak, and major stroke/paraplegia after endovascular treatment. RESULTS: The etiologies of ruptured thoracic aortic disease were aortic dissection (n = 11, 29.7%), intramural hematoma (n = 7, 18.9%), thoracic aortic aneurysm (n = 14, 37.8%), and traumatic aortic transection (n = 5, 13.5%). Three patients died within 24 hours of thoracic endovascular aortic repair, and one showed type I endoleak. The technical success rate was 89.2% (33/37). The in-hospital mortality rate was 13.5% (5/37); no deaths occurred during follow-up. The composite outcome rate during follow-up was 37.8% (14/37), comprising death (n = 5, 13.5%), secondary intervention (n = 5, 13.5%), endoleak (n = 5, 13.5%), and major stroke/paraplegia (n = 3, 8.1%). Left subclavian artery revascularization and proximal landing zone were not associated with the composite outcome. Low mean arterial pressure (MAP; ≤ 60 mmHg, [hazard ratio, 13.018; 95% confidence interval, 2.435 to 69.583, p = 0.003]) was the most significant predictor and high transfusion requirement in the first 24 hours was associated with event-free survival (log rank p = 0.018). CONCLUSIONS: Endovascular treatment achieves high technical success rates and acceptable clinical outcome. High transfusion volume and low MAP were associated with poor clinical outcomes. The Korean Association of Internal Medicine 2021-03 2020-04-10 /pmc/articles/PMC8009169/ /pubmed/32264656 http://dx.doi.org/10.3904/kjim.2019.080 Text en Copyright © 2021 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Choi, Jong Hyun
Kim, Sang-Pil
Lee, Han Cheol
Park, Tae Sik
Park, Jong Ha
Kim, Bo Won
Ahn, Jinhee
Park, Jin Sup
Lee, Hye Won
Oh, Jun-Hyok
Choi, Jung Hyun
Cha, Kwang Soo
Hong, Taek Jong
Clinical outcomes of endovascular treatment for ruptured thoracic aortic disease
title Clinical outcomes of endovascular treatment for ruptured thoracic aortic disease
title_full Clinical outcomes of endovascular treatment for ruptured thoracic aortic disease
title_fullStr Clinical outcomes of endovascular treatment for ruptured thoracic aortic disease
title_full_unstemmed Clinical outcomes of endovascular treatment for ruptured thoracic aortic disease
title_short Clinical outcomes of endovascular treatment for ruptured thoracic aortic disease
title_sort clinical outcomes of endovascular treatment for ruptured thoracic aortic disease
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009169/
https://www.ncbi.nlm.nih.gov/pubmed/32264656
http://dx.doi.org/10.3904/kjim.2019.080
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