Outcomes after stent graft therapy for dissection-related XXXX in the descending thoracic aorta.

@entity1 @entity2759 @entity439 @entity397 @entity715 @entity1580
OBJECTIVE: Stent graft therapy has emerged as an alternative to open surgery in the management of chronic dissection-related @entity439 (DRAD) in the descending thoracic aorta (DTA). The incidence of perioperative complications, need for secondary aortic intervention (SAI), and rate of @entity715 have not been thoroughly described. METHODS: Perioperative and midterm outcomes in @entity1 who underwent stent graft therapy for chronic DRAD DTA at a single institution between January 2006 and September 2013 were retrospectively analyzed. Preoperative anatomic factors, including the number of visceral and renal side branches off the false lumen, and false lumen volume, were analyzed for their ability to predict treatment failure. Treatment failure was defined as death, need for a SAI, and failure to achieve @entity715 of the DRAD DTA. Treatment success was defined as @entity715 of the false lumen in the area of the DRAD DTA with stability or a decrease in the maximum diameter of the DRAD DTA. RESULTS: During the study period, 47 @entity1 underwent stent graft therapy for chronic DRAD DTA. @entity1 were a mean age of 58.3     11.7  years, 74.5% (n  = 35) were male, and 14.9% (n  = 7) had a history of connective tissue disease. The left subclavian artery was covered in 48.9% (n  = 23), and revascularization was performed in 87.0% (n  = 20). Spinal drains were used in 74.5% (n  = 35). @entity2759 developed in 6.4% (n  = 3), which resolved in two and improved in one. No retrograde @entity1580 occurred. The 30-day mortality was 4.3% (n  = 2); one death was in a @entity1 with @entity397 . Mean clinical follow-up was 35.1     20.9  months. The 5-year Kaplan-Meier survival was 89%     5%. Treatment failure occurred in 18 @entity1 (38.3%): 9 required SAIs, 6 did not have @entity715 of the false lumen in the area of the DRAD DTA, and 4 died, with 1 @entity1 dying during a SAI. No preoperative anatomic factor predicted treatment failure. The 5-year freedom from treatment failure was 54%     9%. Including the nine @entity1 who underwent SAI, treatment success was achieved in 85.2% of @entity1 . CONCLUSIONS: In this single-center experience of stent graft therapy for chronic DRAD DTA, treatment success was achieved in 85% of @entity1 after a SAI rate of 20%. No preoperative anatomic factor predicted treatment failure, which occurred in almost 40% of the @entity1 . Identifying predictors of treatment failure may improve future outcomes.
