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• W4366000462 abstract "Management of aortic dissection is rapidly evolving. The present study aims to assess paradigm shifts in type B aortic dissection (TBAD) treatment modalities and their outcomes according to clinical presentation and type of treatment. We also aim to assess the impact of endovascular technology in TBAD management in order to define organizational strategies to provide an integrated cardiovascular approach. We performed a retrospective review with descriptive analysis of the last 100 consecutive patients with TBAD admitted to the Vascular Surgery Department of Centro Hospitalar Universitário Lisboa Norte over a 16-year period. Results were stratified according to treatment modality and stage of the disease. The study was further divided into two time periods, 2003–2010 and 2011–2019, respectively before and after the introduction of a dedicated endovascular program for aortic dissections. A total of 100 patients (83% male; mean age 60 years) were included, of whom 59 were admitted in the acute stage (50.8% with complicated dissections). The other 41 patients were admitted for chronic dissections, most of them for surgical treatment of aneurysmal degeneration. Temporal analysis demonstrated an increase in the number of patients operated for aortic dissection, mainly due to an increase in chronic patients (33.3% in 2003–2010 vs. 64.4% in 2011–2019) and a clear shift toward endovascular treatment from 2015 onward. Overall in-hospital mortality was 14% and was significantly higher in the chronic phase (acute 5.1% vs. chronic 26.8%; OR 5.30, 95% CI 1.71–16.39; p=0.003) and in patients with aneurysmal degeneration, regardless of the temporal phase. Only one death was recorded in the endovascular group. Management of TABD carried an overall mortality of 14% during a 16-year period, but the appropriate use of endovascular technology has substantially reduced in-hospital mortality. O tratamento da dissecção de aorta está em rápida evolução. O presente estudo tem como objetivo avaliar as diferentes técnicas disponíveis para o tratamento da dissecção da aorta tipo B (DATB) e os resultados de acordo com a apresentação clínica e o tipo de tratamento. Adicionalmente, foi avaliado o impacto da introdução da tecnologia endovascular na gestão da DATB com o objetivo de definir estratégias institucionais de forma a fornecer uma abordagem cardiovascular integrada. Foi realizada uma revisão retrospetiva e análise descritiva dos últimos 100 doentes, consecutivos, com DATB admitidos no Serviço de Cirurgia Vascular do Centro Hospitalar Universitário Lisboa Norte durante 16 anos. Os resultados foram estratificados de acordo com a modalidade de tratamento e o estadio da doença. O estudo foi dividido em dois períodos temporais, 2003-2010 e 2011-2019, respetivamente antes e depois da introdução de um programa endovascular para dissecções da aorta. Foram incluídos 100 doentes (83% do sexo masculino; média de 60 anos). Dos doentes, 59 foram admitidos na fase aguda, dos quais 50,8% apresentavam dissecções complicadas, e 41 doentes foram internados por dissecções crónicas, a maioria para tratamento cirúrgico de degenerescência aneurismática. A análise temporal demonstrou um aumento relativo do número de doentes operados por dissecção aórtica, principalmente devido ao aumento de doentes operados na fase crónica (33,3% versus 64,4%; 2003-2010 versus 2011-2019) e uma mudança de paradigma para o tratamento endovascular de 2015 em diante. A mortalidade hospitalar geral foi de 14%, sendo significativamente maior na fase crónica (aguda 5,1% versus crónica 26,8%, OR 5,30, IC 95%, 1,71-16,39; p=0,003) e nos doentes com dilatação aneurismática, independentemente da fase temporal. No subgrupo endovascular foi registado apenas um óbito. O tratamento do DATB apresentou uma mortalidade global de 14% durante um intervalo de 16 anos. Contudo, a introdução de técnicas endoluminais reduziu substancialmente a mortalidade hospitalar." @default.
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• W4366000462 date "2023-07-01" @default.
• W4366000462 modified "2023-10-18" @default.
• W4366000462 title "The evolution of management of type B aortic dissection in a series of 100 consecutive cases in a tertiary center" @default.
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• W4366000462 doi "https://doi.org/10.1016/j.repc.2022.11.006" @default.
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