New type A dissection after acute type B aortic dissection
Aortic dissection is a dynamic process that can progress both proximal and distal to the initial entry tear. We sought to determine associations for development of proximal progression or new type A aortic dissection (NTAD) after acute type B dissection (ATBD) and its effect on survival of the patie...
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| Veröffentlicht in: | Journal of vascular surgery 2018-01, Vol.67 (1), p.85-92 |
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| creator | Charlton-Ouw, Kristofer M. Sandhu, Harleen K. Leake, Samuel S. Miller, Charles C. Afifi, Rana O. Azizzadeh, Ali Estrera, Anthony L. Safi, Hazim J. |
| description | Aortic dissection is a dynamic process that can progress both proximal and distal to the initial entry tear. We sought to determine associations for development of proximal progression or new type A aortic dissection (NTAD) after acute type B dissection (ATBD) and its effect on survival of the patient.
We reviewed all cases of acute aortic dissection that we managed from 1999 to 2014. Univariate and bivariate analyses were performed to identify correlates of NTAD. Multivariable regression and proportional hazards regression analysis was done to determine the effect of dissection progression on long-term survival.
Among 477 cases of ATBD managed, 19 (4.0%) patients developed NTAD during a median follow-up of 4.1 (interquartile range, 1.4-7.7) years. Median time from diagnosis of ATBD to NTAD was 124 (interquartile range, 23-1201) days. Baseline predictors for development of NTAD at initial ATBD admission included bicuspid aortic valve (P = .006) and age |
| doi_str_mv | 10.1016/j.jvs.2017.05.121 |
| format | Article |
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We reviewed all cases of acute aortic dissection that we managed from 1999 to 2014. Univariate and bivariate analyses were performed to identify correlates of NTAD. Multivariable regression and proportional hazards regression analysis was done to determine the effect of dissection progression on long-term survival.
Among 477 cases of ATBD managed, 19 (4.0%) patients developed NTAD during a median follow-up of 4.1 (interquartile range, 1.4-7.7) years. Median time from diagnosis of ATBD to NTAD was 124 (interquartile range, 23-1201) days. Baseline predictors for development of NTAD at initial ATBD admission included bicuspid aortic valve (P = .006) and age <60 years (P = .012). Although not statistically significant, point estimates indicate that thoracic endovascular aortic repair was twice as frequent in NTAD cases as in non-NTAD cases. Overall 5-year survival was 70.2%. Patients who had repair of NTAD appear to have longer survival, although this effect is on the margin of statistical significance (P = .051). After risk factor and correlates of NTAD adjustment, this effect was no longer apparent (P = .089).
The natural history of ATBD is such that there is a persistent risk of NTAD, with the highest risk in the first 6 months. Factors associated with NTAD include bicuspid aortic valve and young age. Thoracic endovascular aortic repair did not have a large effect on risk. Timely diagnosis and repair of NTAD are associated with good survival rates. Lifelong surveillance is warranted in all cases of descending thoracic aortic dissection regardless of initial treatment modality.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2017.05.121</identifier><identifier>PMID: 28823864</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute Disease ; Adult ; Age Factors ; Aged ; Aneurysm, Dissecting - diagnostic imaging ; Aneurysm, Dissecting - epidemiology ; Aneurysm, Dissecting - etiology ; Aneurysm, Dissecting - surgery ; Aorta, Thoracic - diagnostic imaging ; Aorta, Thoracic - pathology ; Aorta, Thoracic - surgery ; Aortic Aneurysm, Thoracic - complications ; Aortic Aneurysm, Thoracic - diagnostic imaging ; Aortic Aneurysm, Thoracic - epidemiology ; Aortic Aneurysm, Thoracic - surgery ; Aortic Valve - abnormalities ; Aortography - methods ; Bicuspid Aortic Valve Disease ; Disease Progression ; Endovascular Procedures - methods ; Endovascular Procedures - statistics & numerical data ; Female ; Follow-Up Studies ; Heart Valve Diseases - epidemiology ; Humans ; Incidence ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Tomography, X-Ray Computed - methods ; Treatment Outcome ; Vascular Grafting - methods ; Vascular Grafting - statistics & numerical data</subject><ispartof>Journal of vascular surgery, 2018-01, Vol.67 (1), p.85-92</ispartof><rights>2017</rights><rights>Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-a0334b498cfb108e922474619ec0140141047c5617c101ebf09d49a5221eb8fa3</citedby><cites>FETCH-LOGICAL-c462t-a0334b498cfb108e922474619ec0140141047c5617c101ebf09d49a5221eb8fa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521417317561$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28823864$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Charlton-Ouw, Kristofer M.</creatorcontrib><creatorcontrib>Sandhu, Harleen K.</creatorcontrib><creatorcontrib>Leake, Samuel S.</creatorcontrib><creatorcontrib>Miller, Charles C.</creatorcontrib><creatorcontrib>Afifi, Rana O.</creatorcontrib><creatorcontrib>Azizzadeh, Ali</creatorcontrib><creatorcontrib>Estrera, Anthony L.</creatorcontrib><creatorcontrib>Safi, Hazim J.</creatorcontrib><title>New type A dissection after acute type B aortic dissection</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Aortic dissection is a dynamic process that can progress both proximal and distal to the initial entry tear. We sought to determine associations for development of proximal progression or new type A aortic dissection (NTAD) after acute type B dissection (ATBD) and its effect on survival of the patient.
We reviewed all cases of acute aortic dissection that we managed from 1999 to 2014. Univariate and bivariate analyses were performed to identify correlates of NTAD. Multivariable regression and proportional hazards regression analysis was done to determine the effect of dissection progression on long-term survival.
Among 477 cases of ATBD managed, 19 (4.0%) patients developed NTAD during a median follow-up of 4.1 (interquartile range, 1.4-7.7) years. Median time from diagnosis of ATBD to NTAD was 124 (interquartile range, 23-1201) days. Baseline predictors for development of NTAD at initial ATBD admission included bicuspid aortic valve (P = .006) and age <60 years (P = .012). Although not statistically significant, point estimates indicate that thoracic endovascular aortic repair was twice as frequent in NTAD cases as in non-NTAD cases. Overall 5-year survival was 70.2%. Patients who had repair of NTAD appear to have longer survival, although this effect is on the margin of statistical significance (P = .051). After risk factor and correlates of NTAD adjustment, this effect was no longer apparent (P = .089).
The natural history of ATBD is such that there is a persistent risk of NTAD, with the highest risk in the first 6 months. Factors associated with NTAD include bicuspid aortic valve and young age. Thoracic endovascular aortic repair did not have a large effect on risk. Timely diagnosis and repair of NTAD are associated with good survival rates. Lifelong surveillance is warranted in all cases of descending thoracic aortic dissection regardless of initial treatment modality.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aneurysm, Dissecting - diagnostic imaging</subject><subject>Aneurysm, Dissecting - epidemiology</subject><subject>Aneurysm, Dissecting - etiology</subject><subject>Aneurysm, Dissecting - surgery</subject><subject>Aorta, Thoracic - diagnostic imaging</subject><subject>Aorta, Thoracic - pathology</subject><subject>Aorta, Thoracic - surgery</subject><subject>Aortic Aneurysm, Thoracic - complications</subject><subject>Aortic Aneurysm, Thoracic - diagnostic imaging</subject><subject>Aortic Aneurysm, Thoracic - epidemiology</subject><subject>Aortic Aneurysm, Thoracic - surgery</subject><subject>Aortic Valve - abnormalities</subject><subject>Aortography - methods</subject><subject>Bicuspid Aortic Valve Disease</subject><subject>Disease Progression</subject><subject>Endovascular Procedures - methods</subject><subject>Endovascular Procedures - statistics & numerical data</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart Valve Diseases - epidemiology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Treatment Outcome</subject><subject>Vascular Grafting - methods</subject><subject>Vascular Grafting - statistics & numerical data</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1Lw0AQhhdRbK3-AC-So5fEmc3mY_VUi19Q9KLnZbuZwIa2qbtJpf_eLaniSRgYhnnmhXkYu0RIEDC_aZJm6xMOWCSQJcjxiI0RZBHnJchjNoZCYJxxFCN25n0DgJiVxSkb8bLkaZmLMbt9pa-o220omkaV9Z5MZ9t1pOuOXKRN39GwvY906zpr_kDn7KTWS08Xhz5hH48P77PneP729DKbzmMjct7FGtJULIQsTb1AKElyLgqRoyQDKEIhiMJkORYmPEWLGmQlpM44D0NZ63TCrofcjWs_e_KdWllvaLnUa2p7r1CmINMcMwgoDqhxrfeOarVxdqXdTiGovTLVqKBM7ZUpyFRQFm6uDvH9YkXV78WPowDcDQCFJ7eWnPLG0tpQZV0woarW_hP_DWd2efU</recordid><startdate>201801</startdate><enddate>201801</enddate><creator>Charlton-Ouw, Kristofer M.</creator><creator>Sandhu, Harleen K.</creator><creator>Leake, Samuel S.</creator><creator>Miller, Charles C.</creator><creator>Afifi, Rana O.</creator><creator>Azizzadeh, Ali</creator><creator>Estrera, Anthony L.</creator><creator>Safi, Hazim J.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201801</creationdate><title>New type A dissection after acute type B aortic dissection</title><author>Charlton-Ouw, Kristofer M. ; Sandhu, Harleen K. ; Leake, Samuel S. ; Miller, Charles C. ; Afifi, Rana O. ; Azizzadeh, Ali ; Estrera, Anthony L. ; Safi, Hazim J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c462t-a0334b498cfb108e922474619ec0140141047c5617c101ebf09d49a5221eb8fa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aneurysm, Dissecting - diagnostic imaging</topic><topic>Aneurysm, Dissecting - epidemiology</topic><topic>Aneurysm, Dissecting - etiology</topic><topic>Aneurysm, Dissecting - surgery</topic><topic>Aorta, Thoracic - diagnostic imaging</topic><topic>Aorta, Thoracic - pathology</topic><topic>Aorta, Thoracic - surgery</topic><topic>Aortic Aneurysm, Thoracic - complications</topic><topic>Aortic Aneurysm, Thoracic - diagnostic imaging</topic><topic>Aortic Aneurysm, Thoracic - epidemiology</topic><topic>Aortic Aneurysm, Thoracic - surgery</topic><topic>Aortic Valve - abnormalities</topic><topic>Aortography - methods</topic><topic>Bicuspid Aortic Valve Disease</topic><topic>Disease Progression</topic><topic>Endovascular Procedures - methods</topic><topic>Endovascular Procedures - statistics & numerical data</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart Valve Diseases - epidemiology</topic><topic>Humans</topic><topic>Incidence</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Treatment Outcome</topic><topic>Vascular Grafting - methods</topic><topic>Vascular Grafting - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Charlton-Ouw, Kristofer M.</creatorcontrib><creatorcontrib>Sandhu, Harleen K.</creatorcontrib><creatorcontrib>Leake, Samuel S.</creatorcontrib><creatorcontrib>Miller, Charles C.</creatorcontrib><creatorcontrib>Afifi, Rana O.</creatorcontrib><creatorcontrib>Azizzadeh, Ali</creatorcontrib><creatorcontrib>Estrera, Anthony L.</creatorcontrib><creatorcontrib>Safi, Hazim J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Charlton-Ouw, Kristofer M.</au><au>Sandhu, Harleen K.</au><au>Leake, Samuel S.</au><au>Miller, Charles C.</au><au>Afifi, Rana O.</au><au>Azizzadeh, Ali</au><au>Estrera, Anthony L.</au><au>Safi, Hazim J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>New type A dissection after acute type B aortic dissection</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2018-01</date><risdate>2018</risdate><volume>67</volume><issue>1</issue><spage>85</spage><epage>92</epage><pages>85-92</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><abstract>Aortic dissection is a dynamic process that can progress both proximal and distal to the initial entry tear. We sought to determine associations for development of proximal progression or new type A aortic dissection (NTAD) after acute type B dissection (ATBD) and its effect on survival of the patient.
We reviewed all cases of acute aortic dissection that we managed from 1999 to 2014. Univariate and bivariate analyses were performed to identify correlates of NTAD. Multivariable regression and proportional hazards regression analysis was done to determine the effect of dissection progression on long-term survival.
Among 477 cases of ATBD managed, 19 (4.0%) patients developed NTAD during a median follow-up of 4.1 (interquartile range, 1.4-7.7) years. Median time from diagnosis of ATBD to NTAD was 124 (interquartile range, 23-1201) days. Baseline predictors for development of NTAD at initial ATBD admission included bicuspid aortic valve (P = .006) and age <60 years (P = .012). Although not statistically significant, point estimates indicate that thoracic endovascular aortic repair was twice as frequent in NTAD cases as in non-NTAD cases. Overall 5-year survival was 70.2%. Patients who had repair of NTAD appear to have longer survival, although this effect is on the margin of statistical significance (P = .051). After risk factor and correlates of NTAD adjustment, this effect was no longer apparent (P = .089).
The natural history of ATBD is such that there is a persistent risk of NTAD, with the highest risk in the first 6 months. Factors associated with NTAD include bicuspid aortic valve and young age. Thoracic endovascular aortic repair did not have a large effect on risk. Timely diagnosis and repair of NTAD are associated with good survival rates. Lifelong surveillance is warranted in all cases of descending thoracic aortic dissection regardless of initial treatment modality.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28823864</pmid><doi>10.1016/j.jvs.2017.05.121</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease Adult Age Factors Aged Aneurysm, Dissecting - diagnostic imaging Aneurysm, Dissecting - epidemiology Aneurysm, Dissecting - etiology Aneurysm, Dissecting - surgery Aorta, Thoracic - diagnostic imaging Aorta, Thoracic - pathology Aorta, Thoracic - surgery Aortic Aneurysm, Thoracic - complications Aortic Aneurysm, Thoracic - diagnostic imaging Aortic Aneurysm, Thoracic - epidemiology Aortic Aneurysm, Thoracic - surgery Aortic Valve - abnormalities Aortography - methods Bicuspid Aortic Valve Disease Disease Progression Endovascular Procedures - methods Endovascular Procedures - statistics & numerical data Female Follow-Up Studies Heart Valve Diseases - epidemiology Humans Incidence Kaplan-Meier Estimate Male Middle Aged Retrospective Studies Risk Assessment Risk Factors Time Factors Tomography, X-Ray Computed - methods Treatment Outcome Vascular Grafting - methods Vascular Grafting - statistics & numerical data |
| title | New type A dissection after acute type B aortic dissection |
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