Brunkwall, J., Kasprzak, P., Verhoeven, E., Heijmen, R., Taylor, P., Alric, P., Canaud, L., Janotta, M., Raithel, D., Malina, M., Resch, Ti, Eckstein, H. -H., Ockert, S., Larzon, T., Carlsson, F., Schumacher, H., Classen, S., Schaub, P., Lammer, J., Lonn, L., Clough, R. E., Rampoldi, V., Trimarchi, S., Fabiani, J. -N., Boeckler, D., Kotelis, D., Boeckler, D., Kotelis, D., von Tenng-Kobligk, H., Mangialardi, N., Ronchey, S., Dialetto, G. and Matoussevitch, V. (2014). Endovascular Repair of Acute Uncomplicated Aortic Type B Dissection Promotes Aortic Remodelling: 1 Year Results of the ADSORB Trial. Eur. J. Vasc. Endovasc. Surg., 48 (3). S. 285 - 292. LONDON: W B SAUNDERS CO LTD. ISSN 1532-2165

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Abstract

Objectives: Uncomplicated acute type B aortic dissection (AD) treated conservatively has a 10% 30-day mortality and up to 25% need intervention within 4 years. In complicated AD, stent grafts have been encouraging. The aim of the present prospective randomised trial was to compare best medical treatment (BMT) with BMT and Gore TAG stent graft in patients with uncomplicated AD. The primary endpoint was a combination of incomplete/no false lumen thrombosis, aortic dilatation, or aortic rupture at 1 year. Methods: The AD history had to be less than 14 days, and exclusion criteria were rupture, impending rupture, malperfusion. Of the 61 patients randomised, 80% were DeBakey type IIIB. Results: Thirty-one patients were randomised to the BMT group and 30 to the BMT+TAG group. Mean age was 63 years for both groups. The left subclavian artery was completely covered in 47% and in part in 17% of the cases. During the first 30 days, no deaths occurred in either group, but there were three crossovers from the BMT to the BMT TAG group, all due to progression of disease within 1 week. There were two withdrawals from the BMT+TAG group. At the 1-year follow up there had been another two failures in the BMT group: one malperfusion and one aneurysm formation (p = .056 for all). One death occurred in the BMT TAG group. For the overall endpoint BMT+TAG was significantly different from BMT only (p < .001). Incomplete false lumen thrombosis, was found in 13 (43%) of the TAG+BMT group and 30 (97%) of the BMT group (p < .001). The false lumen reduced in size in the BMT+TAG group (p < .001) whereas in the BMT group it increased. The true lumen increased in the BMT TAG (p < .001) whereas in the BMT group it remained unchanged. The overall transverse diameter was the same at the beginning and after 1 year in the BMT group (42.1 mm), but in the BMT+TAG it decreased (38.8 mm; p = .062). Conclusions: Uncomplicated AD can be safely treated with the Gore TAG device. Remodelling with thrombosis of the false lumen and reduction of its diameter is induced by the stent graft, but long term results are needed. (C) 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Brunkwall, J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kasprzak, P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Verhoeven, E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heijmen, R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Taylor, P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Alric, P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Canaud, L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Janotta, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Raithel, D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Malina, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Resch, TiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Eckstein, H. -H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ockert, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Larzon, T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Carlsson, F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schumacher, H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Classen, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schaub, P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lammer, J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lonn, L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Clough, R. E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rampoldi, V.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Trimarchi, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fabiani, J. -N.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boeckler, D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kotelis, D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boeckler, D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kotelis, D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
von Tenng-Kobligk, H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mangialardi, N.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ronchey, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dialetto, G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Matoussevitch, V.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-431084
DOI: 10.1016/j.ejvs.2014.05.012
Journal or Publication Title: Eur. J. Vasc. Endovasc. Surg.
Volume: 48
Number: 3
Page Range: S. 285 - 292
Date: 2014
Publisher: W B SAUNDERS CO LTD
Place of Publication: LONDON
ISSN: 1532-2165
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
FALSE LUMEN; INTERNATIONAL REGISTRY; ENTRY TEAR; THROMBOSIS; INSIGHTS; FENESTRATION; SURGERYMultiple languages
Surgery; Peripheral Vascular DiseaseMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/43108

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