Favorable impact of thoracic endovascular aortic repair on survival of patients with acute uncomplicated type B aortic dissection

Iannuzzi, James C.; Stapleton, Sahael M.; Bababekov, Yanik J.; Chang, David C.; Lancaster, Robert T.; Conrad, Mark F.; Cambria, Richard P.; Patel, Virendra I.

doi:10.1016/j.jvs.2018.04.034

Cited by 65 publications

(47 citation statements)

References 23 publications

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“…Survival rates in patients with TBAD after TEVAR have been reported to range from 81.5% to 91.9% at 1 year and from 76% to 89.2% at 5 years. 9,12,33,34 In medically treated patients, survival rates ranged from 84% to 90.2% at 1 year and from 60% to 86.8% at 5-year. 9,12,34 Although the ADSORB trial is the first randomized trial on acute dissection, it was underpowered for survival and had a cut-off at 1-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…9,12,33,34 In medically treated patients, survival rates ranged from 84% to 90.2% at 1 year and from 60% to 86.8% at 5-year. 9,12,34 Although the ADSORB trial is the first randomized trial on acute dissection, it was underpowered for survival and had a cut-off at 1-year follow-up. The INSTEAD-XL (Investigation of Stent Grafts in Aortic Dissection with Extended Follow-Up) trial is the only prospective randomized trial to investigate the long-term outcomes of TEVAR for uncomplicated aortic dissections.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of mid-term outcomes of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection

Xiang¹,

Kan²,

Liang³

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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Objectives: To further assess the early and mid-term outcomes of thoracic endovascular aortic repair (TEVAR) in patients with acute uncomplicated type B aortic dissection (TBAD) compared with those receiving best medical treatment (BMT). Methods: Between February 2008 and March 2018, 357 consecutive patients with acute uncomplicated TBAD were retrospectively analyzed. Among them, 191 patients underwent TEVAR, and 166 received BMT. After propensity score matching, we obtained 145 matched pairs for analysis. Results: In the matched population, the 30-day mortality between the TEVAR group and the BMT group showed no statistically significant difference, whereas the early adverse events rates in the TEVAR group were significantly greater than that of the BMT group (P ¼ .003). Freedom from all-cause mortality in the TEVAR group was significantly greater than that of the BMT group (TEVAR: 91.9% at 5 years, BMT: 82.2% at 5 years, P ¼ .028). Freedom from aortic-related mortality in the TEVAR group was significantly greater than that of the BMT group (TEVAR: 94.1% at 5 years, BMT: 86.1% at 5 years, P ¼ .044). Multivariable Cox-hazard regression analysis demonstrated that the older age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.01-1.08, P ¼ .013), BMT (HR, 2.33; 95% CI, 1.08-5.05, P ¼ .032), and the distance between the primary entry tear and the left subclavian artery<2.0 cm (HR, 2.30; 95% CI, 1.06-4.99, P ¼ .035) were the significant risk factors for all-cause death. Given death as a competing factor, the cumulative incidence of rupture in the BMT group was significantly greater than that of the TEVAR group (BMT: 13.7% at 5 years, TEVAR: 5.1% at 5 years, P ¼ .024). Conclusions: Despite more complications in the early stage, TEVAR was associated with decreased risk of late death and had fewer late aortic ruptures compared with BMT in patients with acute uncomplicated TBAD. Therefore, TEVAR may be considered as the first option to improve the late outcomes in these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of mid-term outcomes of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection

Xiang¹,

Kan²,

Liang³

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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show abstract

“…41 Additionally, a recent retrospective analysis of more than 9,000 patients with acute uncomplicated type B aortic dissections found survival benefit in patients treated with TEVAR over open surgical or medical management. 42 Many operators treat these cohort of patients with aortic stent grafts and this strategy has been validated by this study (►Fig. 4).…”

Section: Aortic Dissectionmentioning

confidence: 89%

Thoracic Aortic Emergencies: Presenting Pathologies and Treatment Strategies

Sheeran

Zelickson

Wilkins

et al. 2020

Semin intervent Radiol

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Thoracic aortic emergencies reflect a wide range of etiologies, pathologic processes, and clinical presentations. Accurate identification with an appropriate treatment algorithm is best accomplished in a multidisciplinary setting with interventional radiologists, vascular surgeons, and cardiothoracic surgeons. While knowledge of thoracic stent graft equipment and technique is essential in the treatment of thoracic aortic emergencies, many clinical settings may employ alternative treatment techniques. This article will review the most common thoracic aortic emergencies and treatment strategies.

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“…The survival rate of patients with traumatic aortic injuries is well-known to be better than that of those with non-traumatic aortic disease [16–20]. We analyzed patients with traumatic aortic injuries separately and observed good results in terms of the survival and freedom from aortic event rates.…”

Section: Discussionmentioning

confidence: 99%

Mid-Term Results of Using the Seal Thoracic Stent Graft in Cases of Aortopathy: A Single-Institution Experience

Cho

Jang

Lee

et al. 2019

Korean J Thorac Cardiovasc Surg

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BackgroundThe endovascular approach to aortic disease treatment has been increasingly utilized in the past 2 decades. This study aimed to determine the long-term results of using the Seal thoracic stent graft.MethodsWe retrospectively reviewed the outcomes of patients who underwent thoracic endovascular aortic repair or a hybrid procedure using the Seal thoracic stent graft (S&G Biotech, Seongnam, Korea) from January 2008 to July 2018 at a single institution. We investigated in-hospital mortality and the incidence of postoperative complications. We also investigated the mid-term survival rate and incidence of aorta-related complications.ResultsAmong 72 patients with stent grafts, 15 patients underwent the hybrid procedure and 21 underwent emergency surgery. The mean follow-up period was 37.86±30.73 months (range, 0–124 months). Five patients (6.9%) died within 30 days. Two patients developed cerebrovascular accidents. Spinal cord injury occurred in 2 patients. Postoperative renal failure, postoperative extracorporeal membrane oxygenation support, and pneumonia were reported in 3, 1, and 6 patients, respectively. Stent-related aortic complications were observed in 5 patients (6.8%). The 1- and 5-year survival and freedom from stent-induced aortic event rates were 81.5% and 58.7%, and 97.0% and 89.1%, respectively.ConclusionThe use of the Seal thoracic stent graft yielded good mid-term results. Further studies are needed to examine the long-term outcomes of this device.

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Favorable impact of thoracic endovascular aortic repair on survival of patients with acute uncomplicated type B aortic dissection

Abstract: This statewide study on survival after acute UTBADs shows an independent survival advantage for TEVAR over medical therapy. These data add further evidence for a paradigm shift in acute management of type B dissection in favor of early TEVAR.

Cited by 65 publications

References 23 publications

Comparison of mid-term outcomes of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection

Comparison of mid-term outcomes of endovascular repair and medical management in patients with acute uncomplicated type B aortic dissection

Thoracic Aortic Emergencies: Presenting Pathologies and Treatment Strategies

Mid-Term Results of Using the Seal Thoracic Stent Graft in Cases of Aortopathy: A Single-Institution Experience

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