Endovascular Repair of Thoracic Aortic Tears

Open versus endovascular repair of acute aortic transections—a non-randomized single-center analysis

“…This initial survival benefit is sustained during midterm follow-up although it did not reach statistical significance (log rank test, p=0.077) due to the relatively small number of patients in both groups. Mortality rates after TEVAR for TAT vary between 0% and 14.2% and are thus in line with our reported results [7,[15][16][17]. Although retrospective series have shown a reduced mortality of TEVAR versus OR, most singlecenter studies, such as ours, failed to show a statistical significance due to the relatively small patient cohorts [6,[18][19][20].…”

2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

“…In a collected series of 284 patients reported in the literature, Lettinga-van de Poll and colleagues reported the procedure-related mortality was 1.5%, 6.7% had endoleaks, and 14.4% had procedure-related complications (358,(365)(366)(367)(368)(369)(370). In a multicenter study of 30 patients with 100% implantation success, 6% to 7% of patients died, 1 had a stroke (3.3%), and 1 had partial stent collapse (3.3%) (370). Reporting bias of favorable results may be an issue regarding interpretation of the safety and efficacy of this approach.…”

Midterm survival after thoracic endovascular aortic repair in more than 10,000 Medicare patients

“…4,5 Initially approved by the US Food and Drug Administration (FDA) only for the treatment of descending thoracic aortic aneurysms, TEVAR devices were often used off-label to treat catastrophes of the descending thoracic aorta-such as acute, complicated, type B aortic dissections and acute, traumatic aortic tears-with reasonable success. [6][7][8][9][10] Several recently published guidelines favor TEVAR over surgery for the treatment (when feasible) of acute catastrophe of the descending thoracic aorta. 11,12 An attempt to further broaden the indications for TEVAR to include uncomplicated chronic type B aortic dissection was undertaken with the Investigation of Stent Grafts in Patients with Type B Aortic Dissection trial (INSTEAD; comparing TEVAR to optimal medical management), the only randomized controlled trial of TEVAR ever completed; however, no improvement in 2-or 5-year all-cause mortality was shown, probably because of the high incidence of nonaneurysmal death (and thus the low overall survival benefit of TEVAR) in patients with uncomplicated type B aortic dissection.…”