Morphology and Outcomes of Total Endovascular Treatment of Type B Aortic Dissection with Aberrant Right Subclavian Artery

Zhou, Min; Bai, Xueqin; Ding, Yong; Wang, Yonggang; Lin, Changpo; Dong, Yan; Shi, Zhenyu; Fu, Weiguo

doi:10.1016/j.ejvs.2017.09.014

Cited by 18 publications

(36 citation statements)

References 29 publications

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“…No study reported a threshold value for the α angle, which varied between 6.12° and 51°. Five studies 1,[16][17][18]28 reported a threshold value for PLS: 5 mm in 4 articles 1,16,18,28 and 3 mm in 1 article. 17 The PLS length varied between 3 and 29 mm.…”

Section: Resultsmentioning

confidence: 99%

“…Among anatomical features, 7 articles [16][17][18][19]24,25,28 reported severe arch angulation as a risk factor for the BBC, but no consistent definition for angulation was used. Proximal landing zones 2 and 3 were also found to be associated with an increased risk of the BBC.…”

Section: Resultsmentioning

confidence: 99%

“…Also, no proven and shared values for the grading of these features are available. In our review, a threshold value for the α angle was not suggested in any article, and only 5 clinical studies 1,[16][17][18]28 and 1 experimental work 39 reported a threshold value for the PLS. No further studies, however, were performed to validate these findings.…”

Section: Discussionmentioning

confidence: 96%

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Impact of the Bird-Beak Configuration on Postoperative Outcome After Thoracic Endovascular Aortic Repair: A Meta-analysis

et al. 2019

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Purpose: To investigate the association between the bird-beak configuration (BBC), a wedge-shaped gap between the undersurface of a thoracic endograft and the lesser curvature of the arch after thoracic endovascular aortic repair (TEVAR), and postoperative outcome after TEVAR. Methods: The study was performed according to the PRISMA guidelines. The PubMed, EMBASE, and Cochrane databases were searched to identify all case series reporting BBC after TEVAR between 2006 and April 2018. Data analysis was performed considering the difference in the risk of complications for presence vs absence of BBC. After screening 1633 articles, 21 studies were identified that matched the selection criteria; 12 of these reported detailed information to investigate the postoperative outcome using proportion meta-analysis with a random effects model. The pooled risk difference is reported with the 95% confidence interval (CI). Heterogeneity of the included studies was assessed with the I2 statistic (low 25%, medium 50%, high 75%). Results: Complications occurred within a range of 0 to 72 months in 14.7% (95% CI 7.4% to 27.3%) of patients with BBC and in 6.3% (95% CI 2.5% to 15.4%) of patients without BBC. A cumulative incidence could not be assessed. The summary risk difference was 11.1% (95% CI −0.1% to 22.3%, p=0.052). There was significant heterogeneity ( I2=85.6%). The Egger test did not show evidence of publication bias (p=0.975). When specifically considering type Ia endoleak and endograft migration, the risk difference between BBC and non-BBC patients was 8.2% (95% CI 0.3% to 16.1%, p=0.042; I2=69.0%). The specific risk difference for endograft collapse/infolding and thrombosis was 3.7% (95% CI −3.5% to 11.1%, p=0.308; I2=10.2%). Conclusion: At present the literature does not provide statistical evidence to establish an overall prognostic value of the BBC. Nevertheless, the BBC appears to be associated with a high risk of type Ia endoleak and endograft migration, which warrants specific and long-term surveillance. Clinically relevant values for BBC grading should be established to perhaps define indications for preemptive treatment based on the presence of BBC only.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

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Impact of the Bird-Beak Configuration on Postoperative Outcome After Thoracic Endovascular Aortic Repair: A Meta-analysis

et al. 2019

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“…Of patients with aortic dissection, 31% have been found to have a bovine arch 1 . Although previous case reports have described thoracic endovascular aortic repair (TEVAR) for type B dissection in the setting of bovine arch or aberrant right subclavian artery using parallel grafts 2 and hybrid arch replacement plus TEVAR into an elephant trunk, 3 the anatomy reported here, treated successfully with carotid-subclavian bypass and TEVAR, has not been published to date.…”

mentioning

confidence: 87%

Acute type B dissection in a patient with anomalous aortic arch anatomy

Malka

Simons

Schanzer

2018

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…Distal endoleaks from intercostal arteries, small fenestrae, or retrograde flow distal to the stent are usually of little hemodynamic significance. Filling of the false lumen from retrograde flow in an aberrant subclavian artery is a rare phenomenon but could be of radiologic importance (65).…”

Section: Partial Thrombosis Of the False Lumen-partialmentioning

confidence: 99%