Endovascular treatment of type B dissection in patients with marfan syndrome: Mid‐term outcomes and aortic remodeling

Eid-Lidt, Guering; Gaspar, Jorge; Meléndez-Ramírez, Gabriela; S, Jorge Cervantes; González‐Pacheco, Héctor; Santos, Félix Damas de los; Meave-González, Aloha; Marroquín, Samuel Ramírez

doi:10.1002/ccd.24725

Cited by 53 publications

(33 citation statements)

References 30 publications

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“…6 In contrast, Eid-Lidt et al achieved 100% primary technical success in a study on 89 patients with MFS with type B dissection who received TEVAR. 15 However, they reported not only a decreased rate of positive aortic remodelling, but also a high rate of secondary endoleaks (44%) and a re-intervention rate of 33%, which is comparable to the results of others. 3,5 Regarding open aortic repair, Ghanta et al reported data from 49 open type II TAAA repairs in patients with MFS with no deaths within 30 days of operation.…”

Section: Discussionsupporting

confidence: 81%

Editor's Choice – Open Thoracic and Thoraco-abdominal Aortic Repair in Patients with Connective Tissue Disease

Keschenau

Kotelis

Bisschop

et al. 2017

European Journal of Vascular and Endovascular Surgery

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Section: Discussionsupporting

confidence: 81%

Editor's Choice – Open Thoracic and Thoraco-abdominal Aortic Repair in Patients with Connective Tissue Disease

Keschenau

Kotelis

Bisschop

et al. 2017

European Journal of Vascular and Endovascular Surgery

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“…The available literature suggests that TEVAR can be unpredictable in patients with a connective tissue disorder and can result in poor outcomes [36][37][38][39]. In a previous study, we noted that in one young patient with a connective tissue disorder and chronic aortic dissection, the patient's aorta expanded extremely rapidly (nearly 4 cm in 3 weeks) after TEVAR [13].…”

Section: Patients With Connective Tissue Disordersmentioning

confidence: 94%

Open aortic surgery after thoracic endovascular aortic repair

Coselli

Spiliotopoulos

Preventza

et al. 2016

Gen Thorac Cardiovasc Surg

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In the last decade, thoracic endovascular aortic aneurysm repair (TEVAR) has emerged as an appealing alternative to the traditional open aortic aneurysm repair. This is largely due to generally improved early outcomes associated with TEVAR, including lower perioperative mortality and morbidity. However, it is relatively common for patients who undergo TEVAR to need a secondary intervention. In select circumstances, these secondary interventions are performed as an open procedure. Although it is difficult to assess the rate of open repairs after TEVAR, the rates in large series of TEVAR cases (>300) have ranged from 0.4 to 7.9 %. Major complications of TEVAR that typically necessitates open distal aortic repair (i.e., repair of the descending thoracic or thoracoabdominal aorta) include endoleak (especially type I), aortic fistula, endograft infection, device collapse or migration, and continued expansion of the aneurysm sac. Conversion to open repair of the distal aorta may be either elective (as for many endoleaks) or emergent (as for rupture, retrograde complicated dissection, malperfusion, and endograft infection). In addition, in select patients (e.g., those with a chronic aortic dissection), unrepaired sections of the aorta may progressively dilate, resulting in the need for multiple distal aortic repairs. Open repairs after TEVAR can be broadly classified as full extraction, partial extraction, or full salvage of the stent-graft. Although full and partial stent-graft extraction imply failure of TEVAR, such failure is generally absent in cases where the stent-graft can be fully salvaged. We review the literature regarding open repair after TEVAR and highlight operative strategies.

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“…Waterman and colleagues reported their experience with 16 patients (5). The pertinent clinical data are summarized in Eid-Lidt and colleagues reported an experience with ten patients, all of whom presented with acute type B dissection with extension into the abdomen (DeBakey type IIIB) (6). Nine of the patients met "high risk" criteria for open repair, however, the criteria were not defined.…”

Section: Perspectivementioning

confidence: 99%

Endovascular surgery in Marfan syndrome: CON

Kouchoukos¹

2017

Ann. Cardiothorac. Surg.

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The frequency of endovascular stent grafting procedures to treat various conditions of the thoracic aorta has increased dramatically over the past three decades. Stent grafting has been applied on a limited basis in patients with Marfan syndrome and other connective tissue disorders, despite recommendations from current guidelines and expert consensus statements against its use in this setting. A review of publications reporting outcomes after stent grafting of the descending thoracic aorta in Marfan patients with acute or chronic aortic dissection indicates that these procedures can be accomplished with rates of early mortality, stroke and spinal cord ischemic injury that are comparable to those observed in patients who do not have Marfan syndrome. However, the rates of primary treatment failure (principally endoleak), secondary treatment failure, need for open repair and late death among the Marfan patients are substantially higher than those observed in patients without this condition. In addition, the rates of retrograde aortic dissection and development of stent-graft induced new entry (SINE), are also greater among patients with Marfan syndrome. All of these findings argue strongly against the routine use of endovascular grafts in Marfan patients with type B or residual type A dissection. Few data are available to assess the role of endografting in Marfan patients with aneurysmal disease, but the progressive aortic dilatation noted in these patients argues strongly against its use in this setting as well. At present, the available data indicate that there is no justification for elective stent grafting in PerspectiveThe frequency of endovascular stent grafting procedures on the thoracic aorta has increased dramatically over the past three decades. In many centers, stent grafting has become the treatment of choice for thoracic aortic aneurysm, dissection, coarctation and traumatic aortic disruption. It has also been used on a limited basis in patients with Marfan syndrome and other connective tissue disorders. At present, endovascular stent grafting for the latter group of patients is considered off-label and current guidelines and expert consensus statements do not recommend endovascular repair (1-3). This manuscript reviews the experience with endovascular stent grafting in Marfan syndrome focusing on patients with aortic dissection involving the descending thoracic aorta and provides evidence to support the recommendation that, with few exceptions, endovascular stent grafting for this condition is not advisable.In 2013, Pacini and colleagues published a systematic review of studies reporting the early and mid-term results of endovascular stent grafting in patients with Marfan syndrome and type B aortic dissection (4). They identified 54 patients from 12 publications who had data suitable for analysis. The mean age of the patients was 40.9 years and approximately 75% were men (data for each of the variables examined in this review were not available for all patients). The majority had undergone a previou...

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Endovascular treatment of type B dissection in patients with marfan syndrome: Mid‐term outcomes and aortic remodeling

Abstract: Our results suggest that TEVAR is feasible, safe, and associated with a high reintervention rate and reduced rate of positive aortic remodeling in patients with Marfan syndrome. Survival at 8 years was comparable to contemporary series of open repair.

Cited by 53 publications

References 30 publications

Editor's Choice – Open Thoracic and Thoraco-abdominal Aortic Repair in Patients with Connective Tissue Disease

Editor's Choice – Open Thoracic and Thoraco-abdominal Aortic Repair in Patients with Connective Tissue Disease

Open aortic surgery after thoracic endovascular aortic repair

Endovascular surgery in Marfan syndrome: CON

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