Long-term outcomes of surgical aortic fenestration for complicated acute type B aortic dissections

Santi Trimarchi, Frederik H W Jonker, Bart E. Muhs, Viviana Grassi, Paolo Righini, Gilbert R. Upchurch, Vincenzo Rampoldi

Research output: Contribution to journalArticle

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Abstract

Introduction: Surgical aortic fenestration has been used for treating ischemic complications of acute type B aortic dissection (ABAD). In the current endovascular era, surgical aortic fenestration may serve as an alternative for these patients after percutaneous failure. The purpose of this study is to describe our surgical suprarenal and infrarenal aortic fenestration technique, and to report the long-term outcomes of this approach in the management of complicated ABAD. Methods: We retrospectively analyzed the in-hospital and long-term outcomes of 18 patients treated with either suprarenal (n = 10) or infrarenal surgical fenestration (n = 8) for complicated ABAD between 1988 and 2002. Suprarenal fenestration was performed through a thoracoabdominal incision in the 10th intercostal space, whereas patients treated with infrarenal fenestration underwent a midline laparotomy. A longitudinal aortotomy was performed and the true and false lumens were identified, followed by a wide resection of the intimal membrane. Results: Median age was 60 years (range, 48-82 years) and 89% (n = 16) were male. The in-hospital mortality was 22% (n = 4), which included two deaths after suprarenal fenestration and two deaths after infrarenal fenestration. In the remaining patients, full visceral, renal, and lower extremity function was recovered, except for 1 patient with paraplegia at admission in which the neurologic deficit was permanent. Median follow-up of the surviving patients was 10.0 years (interquartile range, 12.5; range, 0.5-20 years). During follow-up, none of the patients developed renal or visceral ischemia, or ischemic complications to the lower extremities, and no significant dilatations of the treated aortic segments were noted. Three of 14 patients with ABAD who were discharged alive expired during the follow-up period due to causes unrelated to the surgical procedure. Conclusion: Surgical aortic fenestration represents an effective and durable option for treating ischemic complications of ABAD. Actually, this conservative surgical technique may serve as the alternative treatment in case of contraindications or failure of endovascular management of complicated ABAD.

Original languageEnglish
Pages (from-to)261-266
Number of pages6
JournalJournal of Vascular Surgery
Volume52
Issue number2
DOIs
Publication statusPublished - Aug 2010

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Dissection
Lower Extremity
Tunica Intima
Kidney
Paraplegia
Neurologic Manifestations
Hospital Mortality
Laparotomy
Dilatation
Ischemia
Membranes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Trimarchi, S., Jonker, F. H. W., Muhs, B. E., Grassi, V., Righini, P., Upchurch, G. R., & Rampoldi, V. (2010). Long-term outcomes of surgical aortic fenestration for complicated acute type B aortic dissections. Journal of Vascular Surgery, 52(2), 261-266. https://doi.org/10.1016/j.jvs.2010.02.292

Long-term outcomes of surgical aortic fenestration for complicated acute type B aortic dissections. / Trimarchi, Santi; Jonker, Frederik H W; Muhs, Bart E.; Grassi, Viviana; Righini, Paolo; Upchurch, Gilbert R.; Rampoldi, Vincenzo.

In: Journal of Vascular Surgery, Vol. 52, No. 2, 08.2010, p. 261-266.

Research output: Contribution to journalArticle

Trimarchi, S, Jonker, FHW, Muhs, BE, Grassi, V, Righini, P, Upchurch, GR & Rampoldi, V 2010, 'Long-term outcomes of surgical aortic fenestration for complicated acute type B aortic dissections', Journal of Vascular Surgery, vol. 52, no. 2, pp. 261-266. https://doi.org/10.1016/j.jvs.2010.02.292
Trimarchi, Santi ; Jonker, Frederik H W ; Muhs, Bart E. ; Grassi, Viviana ; Righini, Paolo ; Upchurch, Gilbert R. ; Rampoldi, Vincenzo. / Long-term outcomes of surgical aortic fenestration for complicated acute type B aortic dissections. In: Journal of Vascular Surgery. 2010 ; Vol. 52, No. 2. pp. 261-266.
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AU - Jonker, Frederik H W

AU - Muhs, Bart E.

AU - Grassi, Viviana

AU - Righini, Paolo

AU - Upchurch, Gilbert R.

AU - Rampoldi, Vincenzo

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