Clinical features and efficacy of endovascular intervention in elderly patients with Stanford B aortic dissection

AIM:To summarize the clinical features of elderly patients with Stanford B aortic dissection and to discuss the efficacy and safety of using endovascular intervention in these patients. METHODS: Clinical data and outcomes of endovascular intervention during hospitalization and follow-up were retrospectively analyzed in elderly patients (≥60 years, n=62) and younger patients (<60 years, n=148) who suffered from Stanford B aortic dissection and underwent endovascular intervention between April 2002 and October 2010. RESULTS: The proportion of patients with coronary artery diseases was higher in the elderly group than in the younger group (P<0.01). Trauma, Marfan’s syndrome and polyarteritis were seen in the younger group but penetrating atherosclerotic ulcer was seen only in the elderly group, with no statistical differences in etiology between groups. Chest/back pain was less described as a presentation in the elderly group than in the younger group, whereas lower limb pain, dyspnea and cardiac insufficiency were more often seen in the elderly group (P<0.01). No statistical difference was observed between groups in the course of hypertension, peaks of systolic pressure before and after stent-graft placement and types of hypotensive drugs. The peaks of diastolic pressure before and after endovascular intervention were higher in the younger group compared with those in the elderly population (P<0.05). The success ratios of endovascular therapy were both 100% in the two groups. No statistical differences were seen between groups in the incidences of endovascular leakage, postimplantation syndrome (transient elevations of body temperature and C-reactive protein and mild leukocytosis), incision infection and in-hospital mortality. Chest/back pain postintervention was more frequent in the group of elderly patients (P<0.01). No significant differences were observed between groups during the follow-up period, ratios of clinical and imaging follow-up and occurrence of chest/back pain, endovascular leakage, paraplegia, uncontrolled hypertension and mortality related to aortic dissection during follow-up. Aorta remodelings were seen in all patients who underwent computed tomography, magnetic resonance imaging or aortography during follow up. All-cause mortality in the elderly group was higher than in the younger group (P<0.05). CONCLUSION: To avoid delayed diagnosis and treatment, more attention should be given to the elderly population without classical symptoms of aortic dissection. It is safe and effective to treat elderly patients with Stanford B aortic dissection interventionally in centers with wide experiences.