Aortic Morphologic Findings After Thoracic Endovascular Aortic Repair for Type B Aortic Dissection

Sigman, Michael; Palmer, Owen P.; Ham, Sung W.; Cunningham, Mark J.

doi:10.1001/jamasurg.2014.1327

Cited by 35 publications

(12 citation statements)

References 21 publications

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“…"Favorable" or "positive" aortic remodeling includes true lumen expansion, false lumen regression, complete false lumen thrombosis, and stabilization of overall aortic diameter. [3][4][5][6][7][8] Previous studies on aortic remodeling after TEVAR for aortic dissection (TEVAR-AD) have focused on the changes along the thoracic aorta. [3][4][5][7][8][9][10] The data on the effects of TEVAR-AD on the abdominal aorta have been limited to diameter measurements at few selected abdominal aortic levels and the total volume measurements.…”

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confidence: 99%

“…[3][4][5][6][7][8] Previous studies on aortic remodeling after TEVAR for aortic dissection (TEVAR-AD) have focused on the changes along the thoracic aorta. [3][4][5][7][8][9][10] The data on the effects of TEVAR-AD on the abdominal aorta have been limited to diameter measurements at few selected abdominal aortic levels and the total volume measurements. However, little information, with the exception of occasional reports of branch stenting, is available on the fate of the abdominal aortic branches after TEVAR-AD when it is used in both acute and chronic phases.…”

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confidence: 99%

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Remodeling of abdominal aortic branch perfusion after thoracic endovascular aortic repair for aortic dissections

Han

Kuo

Woo

et al. 2016

Journal of Vascular Surgery

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confidence: 99%

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confidence: 99%

Remodeling of abdominal aortic branch perfusion after thoracic endovascular aortic repair for aortic dissections

Han

Kuo

Woo

et al. 2016

Journal of Vascular Surgery

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“…Atherosclerotic infiltrations of the aorta are a key factor when choosing an appropriate endovascular treatment modality in anatomically suitable patients [1]. The difference in metabolisms of the thoracic and abdominal aorta are becoming more significant due to the present trends towards the use of extensive endovascular treatments vs surgical repair [2].…”

Section: Introduction and Historymentioning

confidence: 99%

The Effects of the Thoracoabdominal Aortic Metabolism on the Endovascular Procedures Outcomes

Novotný¹

2018

IJCTS

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Aortic metabolism is a merge of complex processes. Atherosclerotic infiltration of the aortic wall is a crucial factor when choosing an appropriate endovascular treatment modality for anatomically suitable patients. Due to the rise of endovascular treatments and placement of endovascular devices in younger patients, many physicians are starting to take a more considerable interest in this complex process. Many experimental animal models are used for elucidation of individual aspects in this area. This led to an in-depth explanation of many metabolic processes of the aortic wall. However, only a few papers are reporting on the assessment of these pathological processes in human tissues. This paper outlines some of the crucial aspects of the thoracoabdominal aortic metabolism. Final results of endovascular treatments are believed to be significantly affected by the quality of the aortic wall and the ability to predict its further changes. This includes the pathological changes and their effects on the symbiotic metabolic changes. "Patient-tailored" endovascular aortic treatments based on the aortic metabolic assessment may be able to optimise the cases outcomes. Due to the rise of endovascular treatments and placement of endovascular devices in younger patients, further research is needed to understand better aortic metabolic processes in various patient groups, including groups of patients suffering from chronic metabolic diseases. Aortic wall metabolism should be assessed with the aim to optimise the endovascular treatment outcomes.

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“…It has rapidly become the procedure of choice for treating patients with thoracic disease processes. 1–4 . Numerous prospective, non-randomized and multi-institutional trials have demonstrated reduced or non-inferior morbidity and mortality rates compared with open surgical repair.…”

Section: Introductionmentioning

confidence: 99%

Contemporary evaluation of mortality and stroke risk after thoracic endovascular aortic repair

Fang

Leshnower

et al. 2017

Journal of Vascular Surgery

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Objective Over the past decade, thoracic endovascular aortic repair (TEVAR) has increased as a treatment option for a variety of aortic pathologies. Despite this rise in the use of thoracic stent grafts, real-world outcomes from a robust, adjudicated, contemporary dataset have yet to be reported. Previous studies have shown peri-procedural mortality rates between 1.5%-9.5% and procedure-related stroke rates of 2.3%-8.2%. With advances in device engineering and increased physician experience, we hypothesized that the rates of these complications would be reduced in a more recent sample set. The purpose of this study was to determine current rates of mortality and stroke after TEVAR, identify risk factors that contribute to thirty-day mortality, and develop a simple scoring system that allows for risk stratification of patients undergoing TEVAR. Methods We examined the 30-day mortality rate following TEVAR using the 2013-2014 American College of Surgeons National Surgical Quality Improvement Program database. Patients undergoing TEVAR for all aortic pathology were identified using procedure codes. Bivariate analyses were performed to evaluate the association of pre-, intra- and post-operative variables with 30-day mortality, followed by multivariable logistic analysis using pre-operative variables only, with P<.10 as criteria for model entry. The predictive logistic model was internally validated by cross validation. Variables included in the multivariable model were used to develop a risk score. Results Eight hundred twenty-six patients were included. The thirty-day mortality and stroke rate were 7.63% (n=63) and 4.5% (n= 37), respectively. In regression analysis, mortality was independently associated with age ≥80 years (odds ratio [OR] 2.32, 95% confidence interval [CI] 1.25-4.31), emergency case (OR 2.61, 95% CI 1.39-4.90), ASA classification >3 (OR 2.89, 95% CI 1.34-6.24), transfusion >4 units in the 72 hours prior to surgery (OR 2.86, 95% CI 1.30-6.28), pre-operative creatinine ≥1.8 mg/dL (OR 2.07, 95% CI 1.05-4.08), and pre-operative white blood cell count ≥12 × 109/L (OR 2.65, 95% CI 1.41-4.96). Incorporating these factors, a six-point risk score was generated and demonstrated high predictability for overall thirty-day mortality. Conclusions Recent data from a national, retrospective dataset demonstrate that high perioperative mortality and stroke rates have persisted over the last decade. The risk score derived from this dataset is simple and convenient and serves as a prognostic tool in the pre-operative risk stratification of patients being evaluated for thoracic endovascular aortic repair.

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Aortic Morphologic Findings After Thoracic Endovascular Aortic Repair for Type B Aortic Dissection

Abstract: Favorable aortic remodeling of the thoracic aorta occurs after TEVAR for type B aortic dissections in patients with thoracic FLT and FLP. However, failure to achieve thrombosis of the thoracic false lumen negatively influences aortic morphologic findings of the contiguous abdominal aorta.

Cited by 35 publications

References 21 publications

Remodeling of abdominal aortic branch perfusion after thoracic endovascular aortic repair for aortic dissections

Remodeling of abdominal aortic branch perfusion after thoracic endovascular aortic repair for aortic dissections

The Effects of the Thoracoabdominal Aortic Metabolism on the Endovascular Procedures Outcomes

Contemporary evaluation of mortality and stroke risk after thoracic endovascular aortic repair

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