Hellenic Journal of Surgery
Endovascular Repair of Isolated Abdominal Aortic Dissection.
Dodos I, Theodoridis P, Staramos D, Potouridis A, Iatrou N, Antoniadis P, Argitis V, Dervisis K
Hellenic Journal of Surgery (2018) 90:2, 85-89
Purpose and assumptions
The purpose of this literature review was to investigate,
through literature reports, the possibilities offered by en-
dovascular surgery in the treatment of abdominal aortic
The low number of references makes evidence-based
treatment of this type of dissection particularly difficult,
as there are no specific guidelines. Through this review
of several series of patients with AAD, the indications for
endovascular treatment were evaluated, and the incidence
and nature of postoperative complications were studied,
including the effect of the endografts on the false lumen
and the development of secondary aneurysmal degenera-
tion (aortic remodeling).
Material and method
Ethical approval was not required. A search was con-
ducted in the electronic databases PubMed, Medline and
EMBASE for all articles on AAD. In total, 9 published series
of patients were identified, covering the period 1990-2016,
including a total of 208 patients with AAD. The study
excluded isolated case reports, because most omitted the
postoperative follow-up of the patient. A number of these
case reports, however, were included in the series. In addi-
tion, we excluded from the study one series of 47 patients,
relating to the period 1977-1988, that published by Graham
and colleagues, because we considered that it would not
contribute to safe conclusions about current practice, given
the more recent changes in vascular surgery.
AAD is the least common form of aortic dissection.
Table 1 summarizes the characteristics of the total study
population in the serie s included in this review. In the
208 patients in the 9 most recent series published it was
mostly observed in men, at a rate of 72% (151 males v 57
females). The mean age for disease development was the
Review of the indications for, and the post-operative complications and mortality rates of endovascular
techniques for treating abdominal aortic dissection (AAD).
An electronic health database search was performed using PubMed, Medline and EMBASE for publica-
tions on AAD. The search yielded multiple case reports, which were not included here, and 9 recent series with
sufficient data for analysis.
The series included in the review reported data on a total of 208 patients. Of the AADs recorded, 182 were
spontaneous (87.5%), 13 traumatic (6.25%) and 13 iatrogenic (6.25%), and the majority were of acute presentation
(150 patients, 72%). The mean age of the patients was 62.6 years. Hypertension was the most prevalent risk factor
(133 patients, 64%). Concurrent aortic aneurysms were more often associated with spontaneous dissection (56
patients, 27%). Open surgical repair was performed in 54 patients (26%), endovascular repair in 94 (45%) and the
treatment was conservative in 60 (29%). The in-hospital mortality was 2% for the endovascular group, 5% for the
open repair group and ~7% for those receiving conservative treatment. More complications were reported in the
patients treated by open surgery than in those undergoing endovascular repair.
Patients with AAD are at considerable risk of complications and in-hospital mortality. Based on current
evidence, endovascular treatment appears to be associated with a lower risk of major complications and mortality
than open repair or conservative treatment, and the need for secondary intervention is rare.
Dissection; endovascular therapy; abdominal aorta
Dodos I, Theodoridis P, Staramos D, Potouridis A, Iatrou N,
Antoniadis P, Argitis V, Dervisis K
Department of Vascular Surgery, Nea Ionia General Hospital
Corresponding author: Dodos A. Ilias
Resident Vascular Surgeon
Dionysiou Solomou 18, Palaio Herakleio, 14122 Athens, Greece
Tel.: +30 6979 775169, e-mail: firstname.lastname@example.org
Received Jan 10, 2018; Accepted Feb 25, 2018