Technical and clinical success after endovascular therapy for chronic type B aortic dissections

Oberhuber, Alexander; Winkle, Philipp; Schelzig, Hubert; Orend, Karl-Heinz; Muehling, Bernd M.

doi:10.1016/j.jvs.2011.05.020

Cited by 29 publications

(42 citation statements)

References 27 publications

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“…Our serological study probably covered an appropriate time course and indicated no significant change of parameters with no complications, which supports the notion that endovascular repair is rather less aggressive with insignificant inflammatory modulation and may complementary to some promising early results of recent clinical studies [5], [6], [18]–[21]. Until now, there were only two published studies concerning the inflammatory response in the thoracic aortic pathology after endoluminal stenting but without data on the exact changes of the most important pro-inflammatory mediators at the peri-operative stage [22], [23].…”

Section: Discussionsupporting

confidence: 84%

Changes in Inflammatory Response after Endovascular Treatment for Type B Aortic Dissection

2012

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This present study aims to investigate the changes in the inflammatory markers after elective endovascular treatment of Type B aortic dissection with aneurysm, as related to different anatomical features of the dissection flap in the paravisceral perfusion. Consecutive patients with type B aortic dissections with elective endovascular stent graft repair were recruited and categorized into different groups. Serial plasma levels of cytokines (Interleukin-1β, -6, -8, -10, TNF-α), chemokines (MCP-1), and serum creatinine were monitored at pre-, peri- and post-operative stages. The length of stent graft employed in each surgery was retrieved and correlated with the change of all studied biochemical parameters. A control group of aortic dissected patients with conventional medication management was recruited for comparing the baseline biochemical parameters. In total, 22 endovascular treated and 16 aortic dissected patients with surveillance were recruited. The endovascular treated patients had comparable baseline levels as the non-surgical patients. There was no immediate or thirty day-mortality, and none of the surgical patients developed post-operative mesenteric ischaemia or clinically significant renal impairment. All surgical patients had detectable pro-inflammatory mediators, but none of the them showed any statistical significant surge in the peri-operative period except IL-1β and IL-6. Similar results were obtained when categorized into different groups. IL-1β and IL-6 showed maximal levels within hours of the endovascular procedure (range, 3.93 to 27.3 higher than baseline; p = 0.001), but returned to baseline 1 day post-operatively. The change of IL-1β and IL-6 at the stent graft deployment was statistically greater in longer stent graft (p>0.05). No significant changes were observed in the serum creatinine levels. In conclusion, elective endovascular repair of type B aortic dissection associated with insignificant changes in inflammatory mediators and creatinine. All levels fell toward basal levels post-operatively suggesting that thoracic endovascular aortic repair is rather less aggressive with insignificant inflammatory modulation.

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Section: Discussionsupporting

confidence: 84%

Changes in Inflammatory Response after Endovascular Treatment for Type B Aortic Dissection

2012

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“…Currently, there is no published or ongoing randomized controlled trial that investigates the biomechanical impact of different thoracic stent-grafts, and only a few studies have compared their clinical performance. [171][172][173] This lack of knowledge calls for a deeper investigation of the performance and behavior of different types of thoracic stent-grafts.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection

et al. 2015

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Thoracic endovascular aortic repair (TEVAR) has evolved into an established treatment option for type B aortic dissection (TBAD) since it was first introduced 2 decades ago. Morbidity and mortality have decreased due to the minimally invasive character of TEVAR, with adequate stabilization of the dissection, restoration of true lumen perfusion, and subsequent positive aortic remodeling. However, several studies have reported severe setbacks of this technique. Indeed, little is known about the biomechanical behavior of implanted thoracic stent-grafts and the impact on the vascular system. This study sought to systematically review the performance and behavior of implanted thoracic stent-grafts and related biomechanical aortic changes in TBAD patients in order to update current knowledge and future perspectives.

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“…6,22 In our experimental model, we observed five animals with chronic dissections. Of these, three (60%) survived for more than 14 days without any symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Despite the progress in surgical techniques, perioperative complications and operative mortality remain high in patients with type B aortic dissection. 5 Recently, stent graft placement has become a popular minimally invasive therapy for the treatment of type B aortic dissection [4][5][6][7][8] ; however, this therapeutic method has certain limitations and is not yet established as a standard therapy. There have been several attempts to create aortic dissection models in animals with surgical procedures; these have certainly contributed to the development of advanced therapies.…”

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confidence: 99%

Endovascular creation of aortic dissection in a swine model with technical considerations

Okuno

Yamaguchi

Okada

et al. 2012

Journal of Vascular Surgery

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Technical and clinical success after endovascular therapy for chronic type B aortic dissections

Cited by 29 publications

References 27 publications

Changes in Inflammatory Response after Endovascular Treatment for Type B Aortic Dissection

Changes in Inflammatory Response after Endovascular Treatment for Type B Aortic Dissection

Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection

Endovascular creation of aortic dissection in a swine model with technical considerations

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