ISOLATED ABDOMINAL AORTIC DISSECTION – A DIFFERENT ANIMAL? – CASE SERIES

Authors

  • Duarte Rego Serviço de Angiologia e Cirurgia Vascular do Centro Hospitalar e Universitário do Porto, Portugal
  • Rui Machado Serviço de Angiologia e Cirurgia Vascular do Centro Hospitalar e Universitário do Porto, Portugal
  • Rui Almeida Serviço de Angiologia e Cirurgia Vascular do Centro Hospitalar e Universitário do Porto, Portugal

DOI:

https://doi.org/10.48750/acv.425

Keywords:

Aorta, Aortic Dissection, Endovascular Techniques, Abdominal Aortic Aneurysm

Abstract

Introduction: Isolated abdominal aortic dissection (IAAD) is a relatively rare event and precise indications for treatment aren't clearly defined. Its natural history is not fully understood due to the rarity of the disease and to the fact that most surgeons have a low threshold to intervene in these patients. Open surgery represents the classical treatment but endovascular intervention has gained wide acceptance in most centers and is now the most frequently adopted treatment option. The largest series of treated patients are from Asian centers with the largest of them comprising only 33 cases whereas in western surgical centers the largest series contains only 21 patients.

Methods: Single center, retrospective, observational, study of patients with IAAD who were treated with open or endovascular surgery.

Results: We describe eight patients with IAAD who underwent treatment in our institution (four males and four females). Median age at presentation was 78 years and all patients were asymptomatic. Median aortic diameter at presentation was 30mm (14-85mm). All but one patient underwent endovascular treatment. Three patients were treated with bifurcated aortic endografts, three patients had a single stent-graft (iliac limbs of aortic endografts) implanted and one patient underwent a CERAB procedure for coexistent stenotic disease of the aortic bifurcation. There were no perioperative deaths. Median follow-up was 6,2 years (2 months-13 years). Late reintervention was needed in one patient, 8 years after initial surgery, due to a type 1 endoleak.

Conclusion: According to our experience, endovascular intervention represents a safe and durable treatment option in IAAD, however, long-term follow-up is mandatory. Larger studies with longer follow-ups are needed to understand this disease.

Downloads

Download data is not yet available.

References

Mantelas M, Antonitsis P, Kaitzis D, Hatzibaloglou A, Moros I. Spontaneous isolated dissection of the abdominal aorta: single-center experience. Interact Cardiovasc Thorac Surg. 2009, 8, pp. 398-401.

Trimarchi S, Tsai T, Eagle KA, Isselbacher EM, Froehlich J, Cooper JV, et al. International Registry of Acute Aortic Dissection (IRAD) investigators. Acute abdominal aortic dissection: insight from the International Registry. J Vasc Surg. 2007, 46, pp. 913-9.

Roberts CS, Roberts WC. Aortic dissection with the entrance tear in abdominal aorta. Am Heart J. 1991, 121, pp. 1834-5.

Farber A, Lautherbach SR, Wagner WH, Cossman DV, Long B, Cohen JL, et al. Spontaneous infrarenal abdominal aortic dissection presenting as claudication: case report and review of the literature. Ann Vasc Surg. 2004, 18, pp. 4-10.

Hirst A, Jonhs V, Kime W. Dissecting aneurysms of the aorta: a review of 505 cases. Medicine. 1958, 37, pp. 217-79.

Farber A, Wagner WH, Cossman DV, Cohen JL, Walsh DB, Fillinger MF, et al. Isolated dissection of the abdominal aorta: clinical presen-

tation and therapeutic options. J Vasc Surg. 2002, 36, pp. 205-10.

Cambria RP, Brewster DC, Moncure AC, Steinberg FL, Abbott WM. Spontaneous aortic dissection in the presence of coexistent or previously repaired atherosclerotic aortic aneurysm. Ann Surg. 1988, 208, pp. 619-24.

Jonker FH, Schlösser FJ, Moll FL, Muhs BE. Dissection of the abdominal aorta. Current evidence and implications for treatment strategies: a review and meta-analysis of 92 patients. J Endovasc Ther. 2009, 16, pp. 71-80.

Kouvelos GN, Vourliotakis G, Arnaoutoglou E, Papa N, Avgos S, Peroulis M, et al. Endovascular treatment for isolated acute abdominal aortic dissection. J Vasc Surg. 2013, 58, pp. 1505-11.

Machado R, Rego D, Loureiro L, Almeida R. Endovascular treatment of isolated chronic abdominal aortic dissection. Acta Med Port. 2016, Vol. 29, pp. 224-227.

Jawadi N, Bisdas T, Torsello G, Stavroulakis K, Donas KP. Endo- vascular treatment of isolated abdominal aortic dissections: long-term results. J Endovasc Ther. 2014, 21, pp. 324-8.

Liu Y, Han M, Zhao J, et al. Systematic review and meta-analysis of current literature on isolated abdominal aortic dissection. Eur J Vasc Endovasc Surg. 2020, 59, pp. 545–556.

KangJH,KimYW,HeoSH,WooSY,ParkYJ,KimDI,etal.Treatment strategy based on the natural course of the disease for patients with spontaneous isolated abdominal aortic dissection. J Vasc Surg. 2017, 666, pp. 1668-1678.

Downloads

Published

2022-03-02

How to Cite

1.
Rego D, Machado R, Almeida R. ISOLATED ABDOMINAL AORTIC DISSECTION – A DIFFERENT ANIMAL? – CASE SERIES. Angiol Cir Vasc [Internet]. 2022 Mar. 2 [cited 2022 May 19];17(4):295-8. Available from: https://acvjournal.com/index.php/acv/article/view/425

Issue

Section

Original Article