Mid-Term Outcomes of Complex Endografting for Chronic Post-Dissection Thoracoabdominal Aortic Aneurysms

Verzini, Fabio; Ferrer, Ciro; Parlani, Gianbattista; Coscarella, Carlo; Giudice, Rocco; Frola, Edoardo; Ruffino, Maria Antonella; Varetto, Gianfranco; Gibello, Lorenzo

doi:10.1007/s00270-020-02555-w

Cited by 8 publications

(10 citation statements)

References 36 publications

(31 reference statements)

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“…None of the studies directly compared open and endovascular repair. 2,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] An article quality evaluation is provided in Supplementary Table III (online only), with an aggregate score range of 8 to 11 out of 14. However, it must be considered that, owing to the low incidence of pD-TAAA none of the articles performed sample size calculation, therefore no points were scored in this category.…”

Section: Resultsmentioning

confidence: 99%

Proportional meta-analysis of open surgery or fenestrated endograft repair for postdissection thoracoabdominal aneurysms

Verzini

Gibello

Varetto

et al. 2021

Journal of Vascular Surgery

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Objective: To determine outcomes of postdissection thoracoabdominal aneurysms by either open or endovascular repair with fenestrated or branched endografts.Methods: A systematic review was conducted for open or endovascular repair of postdissection thoracoabdominal aneurysms, between January 2009 and February 2020. A meta-analysis was performed for postoperative complications and both early and late mortality and reinterventions.Results: Fifteen noncomparative studies (eight endovascular repair and seven open repair) were suitable for metaanalysis. Overall, 1337 patients were included, 1068 in the open repair group (73% male; mean age 58 years) and 269 in the endovascular repair group (79% male; mean age 65 years). The 30-day mortality was 6% for open repair vs 3% for endovascular repair (P ¼ .35), whereas the 30-day reintervention rate was 3% for open repair vs 1% for endovascular repair (P ¼ .66). The only significant difference was reported for 30-day respiratory complication rate (30% open repair vs 2% endovascular repair; P < .01). The incidence of spinal cord ischemia was 9% for open repair vs 8% for endovascular repair (P ¼ .95). The mean follow-up was 44 months: 48 months (range, 10-72 months) after open repair and 17 months (range, 12-25 months) after endovascular repair (P < .01). Late aortic reinterventions were more frequent after endovascular repair (11% vs 32%; P < .001). The late overall mortality rate was 19% for open repair vs 7% for endovascular repair (P ¼ .08), whereas aortic-related mortality was 7% for open repair vs 3% for endovascular repair (P ¼ .22).Conclusions: In the absence of comparative studies, this meta-analysis showed that endovascular repair seems to be a viable alternative for patients unfit for open repair.

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Section: Resultsmentioning

confidence: 99%

Proportional meta-analysis of open surgery or fenestrated endograft repair for postdissection thoracoabdominal aneurysms

Verzini

Gibello

Varetto

et al. 2021

Journal of Vascular Surgery

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“…Of these, 203 were excluded for one or more of the following reasons: provided data on aortic arch disease (n = 21); reported on open or hybrid repair (n = 17); provided data on Mesh Stent (n = 1); case reports, technical notes or case series with >10 patients (n = 18); editorial and review articles (n = 6); provided mixed data on TAAs and TAAAs (n = 14); provided mixed data on degenerative TAAAs and PDTAAAs (n = 51); were irrelevant (n = 61); and/or reported on overlapping patient populations (n = 14) (Figure 1). Finally, 10 studies [32][33][34][35][36][37][38][39][40][41], with a total of 585 patients (1255.65 p-ys), were deemed eligible for inclusion in the meta-analysis (Table 1) (Figure 1). CMD: custom-made device; PMSG: physician-modified stent graft.…”

Section: Resultsmentioning

confidence: 99%

“…The mean maximum aneurysm diameter was 60.2 mm (95% CI 56.4 to 63.9). Only five studies [34][35][36]38,40] provided data regarding the nature of dissection for a total of 223 patients; 65 of them (29.1%) had a residual type A AD, and 158 (70.9%) had a chronic type B AD. The vast majority of the patients (78.4%) were operated on in an elective setting, whereas 23.1% and 2.9% of the patients were operated on in an urgent or emergency setting, respectively.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review and an Updated Meta-Analysis of Fenestrated/Branched Endovascular Aortic Repair of Chronic Post-Dissection Thoracoabdominal Aortic Aneurysms

Mylonas,

Aras,

Dorweiler

2024

JCM

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The objective of this study is to present the current outcomes of fenestrated/branched endovascular repair (F/BEVAR) for post-dissection thoracoabdominal aortic aneurysms (PDTAAAs). A systematic review of the literature according to PRISMA guidelines up to October 2023 was conducted (protocol CRD42023473403). Studies were included if ≥10 patients were reported and at least one of the major outcomes was stated. A total of 10 studies with 585 patients overall were included. The pooled estimate for technical success was 94.3% (95% CI 91.4% to 96.2%). Permanent paraplegia developed with a pooled rate of 2.5% (95% CI 1.5% to 4.3%), whereas a cerebrovascular event developed with a pooled rate of 1.6% (95% CI 0.8% to 3.0%). An acute renal function impairment requiring new-onset dialysis occurred with a pooled rate of 2.0% (95% CI 1.0% to 3.8%). Postoperative respiratory failure was observed with a pooled estimate of 5.5% (95% CI 3.8% to 8.1%). The pooled estimate for 12-month overall survival was 90% (95% CI 85% to 93.5%), and the pooled estimates for 24-month and 36-month survival were 87.8% (95% CI 80.9% to 92.5%) and 85.5% (95% CI 76.5% to 91.5%), respectively. Freedom from reintervention was estimated at 83.9% (95% CI 75.9% to 89.6%) for 12 months, 82.8% (95% CI 68.7% to 91.4%) for 24 months and 76.1% (95% CI 60.6% to 86.8%) for 36 months. According to the present findings, F/BEVAR can be performed in PD-TAAAs with high rates of technical success and good mid-term results.

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“…Total endovascular treatment of pD-TAAA in patients deemed unfit for open repair represents a well-accepted approach with encouraging early and midterm results. 3 Usually staged procedures are required, with thoracic endovascular aneurysm repair first and fenestrated or branched endografting as second step to decrease the risk of spinal cord ischemia. In our case, occlusion of the proximal entry of the dissection probably caused increased pressurization of the false lumen, creating a “single entry channel” with the wide lamella interruption at the level of the renal ostia.…”

Section: Discussionmentioning

confidence: 99%

Physician-modified fenestrated Navion endograft for the treatment of a symptomatic postdissection thoracoabdominal aneurysm

Gibello

Frola

Ripepi

et al. 2021

Journal of Vascular Surgery Cases, Innovations and Techniques

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We report the case of a physician-modified four-fenestration endograft for the emergent treatment of a 65-year-old patient with postdissection thoracoabdominal aneurysm deemed unfit for open surgery. The patient, after elective thoracic endovascular aneurysm repair as the first stage of a preplanned two-stage total thoracoabdominal endovascular repair, presented acute onset of dyspnea and thoracic pain. Computed tomography angiography (CTA) showed signs of contained rupture. The Valiant Navion thoracic endograft was used for the creation of a physician-modified fourfenestration stent graft. A diameter-reducing wire technique was used to constrain posteriorly the prosthetic graft and to allow intraprocedural partial deployment. The modified stent graft was finally folded into its original sheath and implanted; four balloon-expandable stent grafts were used as bridging components. Postoperative CTA showed a residual type IIIc endoleak that was treated with a relining procedure 4 months later. At the 20-month follow-up, the patient is alive and well and CTA shows complete seal of the thoracic aneurysm with persisting small type IIIc endoleak in the abdominal aneurysm. A physician-modified endograft can be considered a valuable option in case of urgent treatment of TAAA in patients deemed unfit for open surgery when off-the-shelf devices are not available or contraindicated.

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Mid-Term Outcomes of Complex Endografting for Chronic Post-Dissection Thoracoabdominal Aortic Aneurysms

Cited by 8 publications

References 36 publications

Proportional meta-analysis of open surgery or fenestrated endograft repair for postdissection thoracoabdominal aneurysms

Proportional meta-analysis of open surgery or fenestrated endograft repair for postdissection thoracoabdominal aneurysms

A Systematic Review and an Updated Meta-Analysis of Fenestrated/Branched Endovascular Aortic Repair of Chronic Post-Dissection Thoracoabdominal Aortic Aneurysms

Physician-modified fenestrated Navion endograft for the treatment of a symptomatic postdissection thoracoabdominal aneurysm

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