Long-term Survival and Risk Analysis in 136 Consecutive Patients With Type B Aortic Dissection Presenting to a Single Centre Over an 11 Year Period

Rachel E. Clough; David Barillà; Pascal Delsart; Guillaume Ledieu; Rafaelle Spear; Siobhan Crichton; Claire Mounier Vehier; Janet Peacock; Jonathan Sobocinski; Stephan Haulon

doi:10.1016/j.ejvs.2018.08.042

Long-term Survival and Risk Analysis in 136 Consecutive Patients With Type B Aortic Dissection Presenting to a Single Centre Over an 11 Year Period

Rachel E. Clough, David Barillà, Pascal Delsart, Guillaume Ledieu, Rafaelle Spear, Siobhan Crichton, Claire Mounier Vehier, Janet Peacock, Jonathan Sobocinski, Stephan Haulon^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Objectives: To evaluate, in patients with acute type B aortic dissection, the results of medical and endovascular treatment in a large single centre experience and to investigate the clinical and imaging features on presentation that relate to poor outcome. Methods: This was a retrospective analysis of prospectively collected clinical and CT imaging data. Consecutive patients (136) with acute type B aortic dissection were included in the study over an 11 year period. The characteristics of patients receiving endovascular (complicated) or medical treatment (uncomplicated) were compared. Kaplan–Meier estimators were used to estimate cumulative overall survival and survival free of aortic events. Factors associated with overall and aortic event free survival were also explored using Cox proportional hazards models. Results: The mean follow up was 51 months (1–132), during which time 33 deaths and 48 aortic events occurred. At one and five years, overall survival was 94.0% and 74.8%, respectively, and freedom from aortic events was 75.6% and 58.7%. There was no difference in all cause survival and aortic event free survival at one and five years between the patients treated endovascularly and those receiving medical treatment alone. Risk analysis for aortic events demonstrated the maximum size of the proximal entry tear, the maximum thoracic aortic diameter, and the thoracic aortic false lumen maximum diameter to have a significant effect on the incidence of aortic events. Conclusions: Active management of patients with type B aortic dissection results in good long-term survival even in the presence of features traditionally associated with adverse outcomes. All patients require close lifetime surveillance as aortic events continue to occur during follow up even after endografting.

Original language	English
Journal	European Journal of Vascular and Endovascular Surgery
Early online date	4 Oct 2018
DOIs	https://doi.org/10.1016/j.ejvs.2018.08.042
Publication status	E-pub ahead of print - 4 Oct 2018

Keywords

Aortic dissection
Risk analysis
Survival

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10.1016/j.ejvs.2018.08.042

Long-term survival and risk _CLOUGH_Firstlonline4October2018_GREEN AAM (CC BY-NC-ND)Accepted author manuscript, 272 KBLicence: CC BY-NC-ND

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Clough, R. E., Barillà, D., Delsart, P., Ledieu, G., Spear, R., Crichton, S., Mounier Vehier, C., Peacock, J., Sobocinski, J., & Haulon, S. (2018). Long-term Survival and Risk Analysis in 136 Consecutive Patients With Type B Aortic Dissection Presenting to a Single Centre Over an 11 Year Period. European Journal of Vascular and Endovascular Surgery. Advance online publication. https://doi.org/10.1016/j.ejvs.2018.08.042

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title = "Long-term Survival and Risk Analysis in 136 Consecutive Patients With Type B Aortic Dissection Presenting to a Single Centre Over an 11 Year Period",

abstract = "Objectives: To evaluate, in patients with acute type B aortic dissection, the results of medical and endovascular treatment in a large single centre experience and to investigate the clinical and imaging features on presentation that relate to poor outcome. Methods: This was a retrospective analysis of prospectively collected clinical and CT imaging data. Consecutive patients (136) with acute type B aortic dissection were included in the study over an 11 year period. The characteristics of patients receiving endovascular (complicated) or medical treatment (uncomplicated) were compared. Kaplan–Meier estimators were used to estimate cumulative overall survival and survival free of aortic events. Factors associated with overall and aortic event free survival were also explored using Cox proportional hazards models. Results: The mean follow up was 51 months (1–132), during which time 33 deaths and 48 aortic events occurred. At one and five years, overall survival was 94.0% and 74.8%, respectively, and freedom from aortic events was 75.6% and 58.7%. There was no difference in all cause survival and aortic event free survival at one and five years between the patients treated endovascularly and those receiving medical treatment alone. Risk analysis for aortic events demonstrated the maximum size of the proximal entry tear, the maximum thoracic aortic diameter, and the thoracic aortic false lumen maximum diameter to have a significant effect on the incidence of aortic events. Conclusions: Active management of patients with type B aortic dissection results in good long-term survival even in the presence of features traditionally associated with adverse outcomes. All patients require close lifetime surveillance as aortic events continue to occur during follow up even after endografting.",

keywords = "Aortic dissection, Risk analysis, Survival",

author = "Clough, {Rachel E.} and David Barill{\`a} and Pascal Delsart and Guillaume Ledieu and Rafaelle Spear and Siobhan Crichton and {Mounier Vehier}, Claire and Janet Peacock and Jonathan Sobocinski and Stephan Haulon",

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Clough, RE, Barillà, D, Delsart, P, Ledieu, G, Spear, R, Crichton, S, Mounier Vehier, C, Peacock, J, Sobocinski, J & Haulon, S 2018, 'Long-term Survival and Risk Analysis in 136 Consecutive Patients With Type B Aortic Dissection Presenting to a Single Centre Over an 11 Year Period', European Journal of Vascular and Endovascular Surgery. https://doi.org/10.1016/j.ejvs.2018.08.042

TY - JOUR

T1 - Long-term Survival and Risk Analysis in 136 Consecutive Patients With Type B Aortic Dissection Presenting to a Single Centre Over an 11 Year Period

AU - Clough, Rachel E.

AU - Barillà, David

AU - Delsart, Pascal

AU - Ledieu, Guillaume

AU - Spear, Rafaelle

AU - Crichton, Siobhan

AU - Mounier Vehier, Claire

AU - Peacock, Janet

AU - Sobocinski, Jonathan

AU - Haulon, Stephan

PY - 2018/10/4

Y1 - 2018/10/4

N2 - Objectives: To evaluate, in patients with acute type B aortic dissection, the results of medical and endovascular treatment in a large single centre experience and to investigate the clinical and imaging features on presentation that relate to poor outcome. Methods: This was a retrospective analysis of prospectively collected clinical and CT imaging data. Consecutive patients (136) with acute type B aortic dissection were included in the study over an 11 year period. The characteristics of patients receiving endovascular (complicated) or medical treatment (uncomplicated) were compared. Kaplan–Meier estimators were used to estimate cumulative overall survival and survival free of aortic events. Factors associated with overall and aortic event free survival were also explored using Cox proportional hazards models. Results: The mean follow up was 51 months (1–132), during which time 33 deaths and 48 aortic events occurred. At one and five years, overall survival was 94.0% and 74.8%, respectively, and freedom from aortic events was 75.6% and 58.7%. There was no difference in all cause survival and aortic event free survival at one and five years between the patients treated endovascularly and those receiving medical treatment alone. Risk analysis for aortic events demonstrated the maximum size of the proximal entry tear, the maximum thoracic aortic diameter, and the thoracic aortic false lumen maximum diameter to have a significant effect on the incidence of aortic events. Conclusions: Active management of patients with type B aortic dissection results in good long-term survival even in the presence of features traditionally associated with adverse outcomes. All patients require close lifetime surveillance as aortic events continue to occur during follow up even after endografting.

AB - Objectives: To evaluate, in patients with acute type B aortic dissection, the results of medical and endovascular treatment in a large single centre experience and to investigate the clinical and imaging features on presentation that relate to poor outcome. Methods: This was a retrospective analysis of prospectively collected clinical and CT imaging data. Consecutive patients (136) with acute type B aortic dissection were included in the study over an 11 year period. The characteristics of patients receiving endovascular (complicated) or medical treatment (uncomplicated) were compared. Kaplan–Meier estimators were used to estimate cumulative overall survival and survival free of aortic events. Factors associated with overall and aortic event free survival were also explored using Cox proportional hazards models. Results: The mean follow up was 51 months (1–132), during which time 33 deaths and 48 aortic events occurred. At one and five years, overall survival was 94.0% and 74.8%, respectively, and freedom from aortic events was 75.6% and 58.7%. There was no difference in all cause survival and aortic event free survival at one and five years between the patients treated endovascularly and those receiving medical treatment alone. Risk analysis for aortic events demonstrated the maximum size of the proximal entry tear, the maximum thoracic aortic diameter, and the thoracic aortic false lumen maximum diameter to have a significant effect on the incidence of aortic events. Conclusions: Active management of patients with type B aortic dissection results in good long-term survival even in the presence of features traditionally associated with adverse outcomes. All patients require close lifetime surveillance as aortic events continue to occur during follow up even after endografting.

KW - Aortic dissection

KW - Risk analysis

KW - Survival

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U2 - 10.1016/j.ejvs.2018.08.042

DO - 10.1016/j.ejvs.2018.08.042

M3 - Article

AN - SCOPUS:85054161034

SN - 1078-5884

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

ER -

Long-term Survival and Risk Analysis in 136 Consecutive Patients With Type B Aortic Dissection Presenting to a Single Centre Over an 11 Year Period

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