Outcomes of thoracic endovascular aortic repair for chronic aortic dissections

Conway, Alison; Qato, Khalil; Mondry, Laurie; Stoffels, Guillaume; Giangola, Gary; Carroccio, Alfio

doi:10.1016/j.jvs.2017.08.098

Cited by 43 publications

(27 citation statements)

References 43 publications

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“…[11][12][13] However, several studies have shown that more extensive stent-graft coverage does not convey significant benefits with regard to either FL thrombosis formation 14,15 or aortic diameter change. 16,17 The present study used the percentage of the stented descending aorta (PSDA), calculated by dividing the length of the stented descending aorta by the total length of the descending aorta, as a novel surrogate of the extent of stentgraft coverage. The association between PSDA and the risk of TAE after TEVAR was examined.…”

Section: Introductionmentioning

confidence: 99%

Association Between Extent of Stent-Graft Coverage and Thoracic Aortic Remodeling After Endovascular Repair of Type B Aortic Dissection

Xue

et al. 2020

J Endovasc Ther

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Purpose: To examine the association between the extent of stent-graft coverage and thoracic aortic expansion after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection. Materials and Methods: A retrospective analysis was conducted of 201 patients (mean age 52.4±11.5 years; 178 men) with acute (135, 67.2%) or chronic (66, 32.8%) type B aortic dissection who underwent TEVAR at 4 medical centers. The mean stent-graft length was 157.1±33.3 mm. The percentage of stented descending aorta (PSDA) represented the extent of stent-graft coverage. After using restricted cubic smoothing spline plots to confirm the roughly linear relationship between PSDA and the risk of thoracic aortic expansion, patients were stratified into 2 groups on the median PSDA: the lower group (≤31.3%) and the higher group (>31.3%). Thoracic aortic expansion was defined as a ≥20% increase in the total thoracic aortic volume on the most recent postoperative computed tomography angiography scan compared with the preoperative measurement. The Kaplan-Meier method was used to estimate the cumulative freedom from thoracic aortic expansion after TEVAR; estimates are given with the 95% confidence interval (CI). A multivariable Cox proportional hazards model was used to analyze any independent association of the PSDA as a continuous or categorical variable with the risk of thoracic aortic expansion; results are presented as the hazard ratio (HR) and 95% CI. Results: No patients developed symptoms of spinal cord ischemia during hospitalization. Over a median 12.4 months of imaging follow-up, 34 (16.9%) patients developed thoracic aortic expansion. The estimate of freedom from thoracic aortic expansion at 12 months for the overall PSDA was 84.0% (95% CI 77.8% to 88.6%); between the groups, the freedom from thoracic aortic expansion estimate for the PSDA ≤31.3% group was significantly lower than in the higher group (p=0.032). Regression analysis showed no significant association between the risk of thoracic aortic expansion and the PSDA as a continuous variable (HR 0.97, 95% CI 0.91 to 1.03, p=0.288); however, analyzing the PSDA as a categorical variable indicated a significantly lower risk of thoracic aortic expansion for the PSDA >31.3% group (HR 0.46, 95% CI 0.22 to 0.95, p=0.036) after adjusting for a variety of demographic and anatomical characteristics. Conclusion: More extensive stent-graft coverage appears to improve thoracic aortic remodeling after TEVAR. However, the clinician should balance the benefit of extensive stent-graft coverage and its related risk of spinal cord ischemia.

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Section: Introductionmentioning

confidence: 99%

Association Between Extent of Stent-Graft Coverage and Thoracic Aortic Remodeling After Endovascular Repair of Type B Aortic Dissection

Xue

et al. 2020

J Endovasc Ther

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“…7,21 The approximately 40% female study population in the Valiant Evo trial is very consistent with previous clinical trials although the fraction of women is slightly lower in real-world TEVAR registries where men comprise 70% to 80% of the patient population. 12,22,23 In addition to the large proportion of females in the trials, core laboratory imaging graded 70.9% and 85.7% of the Valiant Evo patients as having severe access artery and high thoracic aorta tortuosity, respectively. Access artery tortuosity can result in a more complicated TEVAR if additional intraoperative procedures such as iliac stenting, or endo-or open iliac conduits become necessary.…”

Section: Discussionmentioning

confidence: 99%

Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

Azizzadeh

Desai

Arko

et al. 2019

Journal of Vascular Surgery

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Objective: The Valiant Navion stent graft system (Medtronic, Santa Rosa, Calif) is a new iteration of a thoracic endograft for the treatment of descending thoracic aortic aneurysms. Herein, the 30-day primary safety and efficacy outcomes and secondary end points are presented. Methods:The Valiant EVO global clinical trial is a prospective, nonrandomized, single-arm trial. Patient enrollment occurred from April 2016 to October 2017. The primary end point was defined as access and/or deployment failure and/or a major device effect (MDE), including device-related secondary procedures, device-related mortality, conversion to open surgery, or thoracic aortic aneurysm rupture within 30 days of the index procedure. Other measures of stent graft performance including procedural data, rates of secondary procedures, and frequency of endoleaks are also reported.Results: Of the 87 consecutive patients undergoing thoracic endovascular aneurysm repair who were enrolled, 33 (37.9%) were female with 61 (70.9%) presenting with severe access artery tortuosity and 66 (85.7%) with high thoracic aortic tortuosity per core laboratory evaluation. The mean procedure duration was 88.7 6 53.4 minutes and geographical differences existed such as percutaneous access (37/52 [71.2%]) in the United States and surgical cut down in the outside of the U.S. sites (28/35 [80.0%]). There were no access or deployment failures and only 2.3% of the patients (2/87; P < .0001; performance goal of 16%) experienced a MDE within 30 days of the index procedure. Two secondary procedures (n ¼ 1 retrograde type A dissection; n ¼ 1 aortic arch rupture) were required, and in the first 30 days, two patients died leading to a freedom from all-cause mortality of 97.7%. Endoleaks at 1 month were reported in 2.5% of patients (n ¼ 1 type Ia; n ¼ 1 type II).Conclusions: Access/deployment failures, MDEs, and endoleaks were rare in the first 30 days of the Valiant Evo clinical trial. The Valiant Navion thoracic stent graft system has shown encouraging 30-day results in this challenging cohort and trial patients will continue to be followed through 5 years. (J Vasc Surg 2019;70:1399-408.)

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“…14) However, complete false lumen thrombosis in chronic aortic dissection occurs only in 40% to 80% of the patients at the level of the device and in 0%-40% of the patients at the level distal to the device. 15) In a prospective cohort study, VIRTUE registry revealed that patients with subacute dissection (15-92 days) demon- Repeat Surgery for Thoracic Aortic Aneurysm strated a similar degree of aortic remodeling compared to patients with acute dissection (< 15 days). 16) However, the rate of remodeling was poorer in the chronic phase (> 92 days).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Open Surgery and Stent Graft Treatment in Patients Undergoing Repeat Thoracic Aortic Aneurysm Repair from Previous Anastomosis Site

Hori

Yasuda

Kusadokoro

et al. 2019

Annals of Vascular Diseases

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Outcomes of thoracic endovascular aortic repair for chronic aortic dissections

Abstract: TEVAR for cTBD may be performed with acceptable rates of morbidity and mortality. Changes in sac diameter in the midterm are promising. Long-term data are needed to determine whether this approach is durable.

Cited by 43 publications

References 43 publications

Association Between Extent of Stent-Graft Coverage and Thoracic Aortic Remodeling After Endovascular Repair of Type B Aortic Dissection

Association Between Extent of Stent-Graft Coverage and Thoracic Aortic Remodeling After Endovascular Repair of Type B Aortic Dissection

Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

Long-Term Outcomes of Open Surgery and Stent Graft Treatment in Patients Undergoing Repeat Thoracic Aortic Aneurysm Repair from Previous Anastomosis Site

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