PURPOSE: In an earlier report, we documented the incidence and @entity2333 complicating @entity697 ( @entity1580 ) over a 21-year interval (1965-1986). In the current study, management of @entity1095 ( @entity1095 ) of @entity1580 over the past decade was reviewed. METHODS: Medical records of @entity1 treated for @entity1580 over the interval January 1, 1990, to December 31, 1999, were reviewed. @entity1 with branch compromise confirmed with radiography or operation and @entity1 with @entity2759 that was based on results of a physical examination defined the study group. Comparisons between subgroups with and without PVC over a 30-year interval were analyzed with the chi(2) test. RESULTS: A total of 187 @entity1 (101 proximal and 86 distal) were treated for @entity1580 over the study interval. A total of 53 (28%) of these @entity1 had clinical evidence of organ or limb malperfusion (7 cerebral, 3 upper extremity, 5 spinal cord, 11 mesenteric, 12 renal, and 24 lower extremity [sites inclusive]), and one of three (17 @entity1 ) of these underwent specific peripheral vascular intervention. The remaining 65% (36) of the PVC group had complete or partial malperfusion resolution after central aortic therapy (medical or surgical) alone. Open techniques for treating PVC included aortic fenestration (9), femorofemoral grafting (2), and aortofemoral grafting (1). All had favorable outcomes with no mortality. Endovascular procedures in five @entity1 included abdominal aortic fenestration (3) or stenting of the renal (2), mesenteric (2), and iliac (1) arteries with clinical success in three @entity1 and two deaths. The in-hospital mortality rate for the entire group of 187 @entity1 was 18% (15% for proximal aortic operation, 8% in medically treated @entity1 ). The presence of aortic branch compromise was not a statistically significant predictor of the @entity1 mortality rate (23% with and 16% without; P =.26). Overall mortality rate in the current study (18% vs 37%; P =.000006) and the mortality rate with PVC (23% vs 51%; P =.001), in particular with @entity5327 (36% vs 87%; P =.026), decreased significantly when compared with prior experience. CONCLUSIONS: The overall mortality rate from @entity1580 during the past decade has decreased significantly. Similar trends were noted in @entity1 with @entity1095 , a previously identified high-risk subgroup. Increased awareness and prompt, specific management of @entity1095 , in particular when @entity63 is present, have contributed to improved outcomes in @entity1 with @entity1580 .

Contemporary management of aortic branch compromise resulting from XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity1095 :: ('MESH:D016491', 'Disease') :: ['PVCs', 'peripheral vascular complications'] @entity697 :: ('MESH:D000208', 'Disease') :: ['acute aortic dissection'] @entity63 :: ('MESH:D007511', 'Disease') :: ['visceral ischemia'] @entity5327 :: ('MESH:D065666', 'Disease') :: ['mesenteric ischemia'] @entity2759 :: ('MESH:D020760', 'Disease') :: ['spinal cord ischemia'] @entity2333 :: ('MESH:D001018', 'Disease') :: ['impact of aortic branch compromise'] @entity1580 :: ('MESH:C562834', 'Disease') :: ['AD']
@entity697 :: (MESH:D000208,Disease) :: ['acute aortic dissection']
