Mid-term outcomes from a multicenter study: Is TEVAR safe for ascending aortic dissection?

Lu, Qingsheng; Liu, Lei; Chang, Guangqi; Chen, Xueming; Feng, Hai; Zhang, Xuemin; Fu, Weiguo; Dong, Zhihui; Jing, Zaiping

doi:10.1016/j.ijcard.2018.04.095

Cited by 25 publications

(33 citation statements)

References 23 publications

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“…The treatment of TAD and TAA involving the aortic arch are high-risk procedures, but with the evolution in endovascular techniques in recent years, a less invasive option with relatively satisfactory clinical outcomes is available for these patients. [2][3][4][5][6][7]11,14,15 Ten years ago, our team started to use endovascular procedures, such as physician-customized fenestrations and chimney techniques, in the aortic arch with satisfactory clinical efficacy. 10,11 ch-TEVAR and f-TEVAR were used for patients with aortic dissections or aneurysms involving the origin of the supra-aortic branches or if a TEVAR landing zone required coverage of a supra-aortic branch.…”

Section: Discussionmentioning

confidence: 99%

“…Thoracic aortic dissection (TAD) and thoracic aortic aneurysm (TAA) involving the aortic arch or its branches are not suitable for standard thoracic endovascular aortic repair (TEVAR), so the procedure is combined with debranching of the supra-aortic vessels 1 or fenestrated/ branched stent-grafts. 2 TEVAR has been widely used in China, [3][4][5][6][7] but no customized fenestrated stent-grafts are available. Thoracic aortic pathologies involving the arch have been treated mainly with chimney TEVAR (ch-TEVAR) or other parallel graft techniques 3,5,7 or on-site construction of fenestrations and branches in commercially available stent-grafts.…”

Section: Introductionmentioning

confidence: 99%

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Off-the-Shelf Devices for Treatment of Thoracic Aortic Diseases: Midterm Follow-up of TEVAR With Chimneys or Physician-Made Fenestrations

Zhang

Zhu

et al. 2019

J Endovasc Ther

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Purpose: To evaluate the midterm outcomes of thoracic endovascular aortic repair (TEVAR) using chimney grafts (ch-TEVAR) or thoracic stent-grafts with fenestrations made on the back table (f-TEVAR) to treat thoracic aortic dissection (TAD) and thoracic aortic aneurysm (TAA). Materials and Methods: A retrospective analysis was conducted of 474 consecutive patients (mean age 62.3±10.7 years; 346 men) treated with either f-TEVAR (n=110) or ch-TEVAR (n=364) for 352 TADs (81 f-TEVAR and 271 ch-TEVAR) or 122 TAAs (29 f-TEVAR and 93 ch-TEVAR) from 2008 to 2016. The primary endpoints at 30 days and during follow-up were overall mortality, aorta-related mortality, and major complications. The secondary endpoints were endoleak and reintervention. The patency of the target branches, cost of hospitalization, and the use of antiplatelet drugs were also analyzed. Results: Intraoperative type I endoleaks were treated in 69 (14.6%) cases (4 f-TEVAR and 65 ch-TEVAR, p<0.01) to achieve 100% technical success. Four (0.8%) patients died within 30 days [1 (0.9%) f-TEVAR and 3 (0.8%) ch-TEVAR]. Perioperative cerebral ischemia (1 fatal stroke) occurred in 9 (1.9%) patients: (1 f-TEVAR and 8 ch-TEVAR, p=0.39). During the mean follow-up of 50.6±20.0 months (49.5±18.3 months in f-TEVAR and 50.9±20.6 months in ch-TEVAR), 11 (2.3%) patients died of an aorta-related event. Type I endoleak was present in 40 (8.4%) patients (1 f-TEVAR and 39 ch-TEVAR, p<0.01). Eleven (2.3%) patients experienced stent-graft migration and 13 (2.7%) had a retrograde dissection. One hundred (16.9%) of the 593 branch stents occluded (4/75 in the f-TEVAR group and 96/518 in the ch-TEVAR group, p<0.01). The branch reintervention rate was 7.2% (34/474). The f-TEVAR group had a significantly higher probability of freedom from branch occlusion (92%) than the ch-TEVAR group (83%, p=0.007). Conclusion: Off-the-shelf techniques employing chimney grafts and homemade fenestrations are both suitable options for TAD and TAA involving the supra-aortic branches, with a low incidence of reintervention. Fenestrated TEVAR seems to have more favorable short- and midterm outcomes. Further study of these off-the-shelf techniques for aortic arch repair is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Off-the-Shelf Devices for Treatment of Thoracic Aortic Diseases: Midterm Follow-up of TEVAR With Chimneys or Physician-Made Fenestrations

Zhang

Zhu

et al. 2019

J Endovasc Ther

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“…All patients who underwent endovascular repair were deemed either unfit or high-risk for open repair, and endovascular stenting was thus considered an alternative safe approach that could provide a better outcome than pure medical management. 14 The largest retrospective study to date was performed by Lu et al 15 This study involved 56 patients and showed promising results with a 30-day survival rate of 92.9% and overall survival rate at follow-up of 80.9% (mean follow-up, 39.92 AE 34.42 months). Most of the deaths that occurred during that period were unrelated to the aortic disease.…”

Section: Ataad: Stenting Versus Open Repairmentioning

confidence: 99%

The future of stenting in patients with type A aortic dissection: a systematic review

2019

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Acute type A aortic dissection (ATAAD) carries high morbidity and mortality rates and is a clinical emergency. The reported mortality rate is 50% to 65% within the first 48 hours without surgical intervention. Open surgery therefore remains the gold standard management for ATAAD. However, in patients who are deemed unfit for surgery and where possible, endovascular repair offers a useful alternative to medical treatment alone or high-risk open surgical repair. Several case reports, case series, and retrospective studies have reported good outcomes following endovascular treatment. The endovascular option also has comparable early and late outcomes, favourable aortic remodelling, and satisfactory overall survival despite having a higherrisk patient cohort. However, stenting in patients with ATAAD undoubtedly still has several limitations and technical challenges.

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“…The preliminary and midterm follow-up results of endovascular repair of AAD in our center have been published. [4][5][6] It is conceivable that the treatment algorithm of AAD would be changed if the selective and evaluative criteria of endovascular therapy could be pooled and provided. To date, however, no systematic review of endovascular repair of AAD has been performed.…”

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confidence: 99%

Systematic review of endovascular repair of ascending aortic dissection

Zhang

et al. 2019

Cathet Cardio Intervent

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Background Endovascular repair has been used in selected ascending aortic dissection patients judged unfit for direct open surgery. However, the selective criteria and the results of endovascular repair of ascending aortic dissection, and the potential risk factors of adverse events were still obscure. The aim of this study was to summarize the published data linking endovascular therapy for ascending aortic dissection. Methods Studies reporting endovascular repair of ascending aortic dissections were identified by searching PubMed and Embase databases in accordance with preferred reporting items for systematic reviews and meta‐analyses guidelines, and by reviewing the reference lists of retrieved articles. All available data were pooled and the subgroup analyses were conducted. Results A total of nine studies were identified according to the inclusion criteria. The overall technical success was 91.7%. The mean period of follow‐up was 34.7 months. The early mortality within 30 days and late mortality during the follow‐up were 10.3% and 19.0%, respectively. The incidence of endoleak was 14.3%. In the subgroup analysis, we found that female and oversizing >10% were risk factors of adverse events. Conclusions The pooled results suggested that endovascular repair of ascending aortic dissection was feasible, promising, and inspiring. The selection of endovascular therapy should be cautious based on preoperative evaluation. Application of different strategies for different ascending lesions should be considered. The dedicated endograft for ascending aorta is desperately needed before broader application of endovascular repair for ascending aortic pathologies can be achieved.

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Mid-term outcomes from a multicenter study: Is TEVAR safe for ascending aortic dissection?

Cited by 25 publications

References 23 publications

Off-the-Shelf Devices for Treatment of Thoracic Aortic Diseases: Midterm Follow-up of TEVAR With Chimneys or Physician-Made Fenestrations

Off-the-Shelf Devices for Treatment of Thoracic Aortic Diseases: Midterm Follow-up of TEVAR With Chimneys or Physician-Made Fenestrations

The future of stenting in patients with type A aortic dissection: a systematic review

Systematic review of endovascular repair of ascending aortic dissection

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