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Background. Acute type B aortic dissection (TBAD) is catastrophic event associated with significant mortality and lifelong morbidity. The optimal treatment strategy of TBAD is still controversial. Methods. This analysis includes patients treated for TBAD at the Helsinki University Hospital, Finland in 2007-2019. The endpoints were early and late mortality, and intervention of the aorta. Results. There were 205 consecutive TBAD patients, 59 complicated and 146 uncomplicated patients (mean age of 66 ± 14, females 27.8%). In-hospital and 30-day mortality rates were higher in complicated patients compared with uncomplicated patients with a statistically significant difference (p = 0.035 and p = 0.015, respectively). After a mean follow-up of 4.9 ± 3.8 years, 36 (25.0%) and 22 (37.9%) TBAD -related adverse events occurred in the uncomplicated and complicated groups, respectively (p = 0.066). Freedom from composite outcome was 83 ± 3% and 69 ± 6% at 1 year, 75 ± 4% and 63 ± 7% at 5 years, 70 ± 5% and 59 ± 7% at 10 years in the uncomplicated group and in the complicated group, respectively (p = 0.052). There were 25 (39.1%) TBAD-related deaths in the overall series and prior aortic aneurysm was the only risk factor for adverse aortic-related events in multivariate analysis (HR 3.46, 95% CI 1.72-6.96, p < 0.001). Conclusion. TBAD is associated with a significant risk of early and late adverse events. Such a risk tends to be lower among patients with uncomplicated dissection, still one fourth of them experience TBAD-related event. Recognition of risk factors in the uncomplicated group who may benefit from early aortic repair would be beneficial. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess the incidence, treatment and outcome of vascular trauma in a well-defined geographical region in Finland. Methods: A retrospective analysis was conducted of patients admitted to Tampere University Hospital (TAUH), Pirkanmaa, Finland, due to vascular trauma between January 2006 and December 2010. Data regarding trauma mechanism, anatomical location, treatment, and short-term outcome were collected from patients' files and vascular register. Results: Altogether, 143 non-iatrogenic vascular traumas occurred during the study period resulting in an annual trauma incidence of 5.8/100,000/year in the TAUH region. The majority of the injuries were located in the upper extremities ( N = 83, 58 %). Penetrating injuries comprised 58 % (83 patients) of all vascular trauma admissions and were significantly more common among men compared to women (83 and 17 %, respectively). The majority ( N = 93, 65 %) of the injuries were treated surgically, while in 15 (11 %) patients the trauma was resolved by endovascular means. The remaining 35 (24 %) patients were successfully managed conservatively, i.e., by observation or wound exploration only without the need for later (30-day) vascular repair. Two out of 17 patients (12 %) with lower extremity vascular trauma required major amputation. Procedure-related complications occurred in five patients. In-hospital and 30-day mortality was zero. Conclusions: This paper demonstrates that the incidence of non-iatrogenic civilian vascular trauma in the Pirkanmaa region is low and mainly caused by penetrating injury. Further, the majority of vascular traumas are still treated surgically. In general, the short-term survival of patients who survive the initial trauma is good. [ABSTRACT FROM AUTHOR]

Background: The International Subarachnoid Aneurysm Trial (ISAT) concluded that “there is currently no reason to doubt that the reduction of dependent survival or death after endovascular coiling seen in all patients in the ISAT cohort should not be valid in the elderly”. We feel that this generalization requires further investigation to assess its validity. Methods: We studied the impact of treatment era and independent risk factors for outcome in 179 consecutive elderly (≥70 years) aneurysmal subarachnoid hemorrhage (aSAH) patients admitted to Kuopio University Hospital either between 1983 and 1992 (Era I, n = 56), prior to the introduction of endovascular management, or between 1995 and 2004 (Era II, n = 123) when the endovascular treatment was established at our institute. Altogether 150 patients underwent occlusive aneurysm treatment, 47 clipping in the Era I as against 49 clipping, 49 endovascular therapy, and five combination therapy in the Era II. Results: The 12-month survival ( n = 179) did not improve from the Era I to the Era II. The proportion of good outcome (GOS IV–V) after occlusive therapy ( n = 150) was equal in the Era I and Era II ( n = 27/47; 57% vs. n = 56/103; 54%). In multivariate logistic regression analysis, independent predictors of poor outcome were age, poor grade (Hunt&Hess IV–V), hydrocephalus, hypertension, and intraventricular hemorrhage, but not the mode of occlusive therapy (microsurgical vs. endovascular) Conclusion: Clinical severity of the SAH was the most significant predictor of outcome. Integration of coil treatment in clinical practice has not improved the overall outcome of aSAH in the elderly at our institute. [ABSTRACT FROM AUTHOR]