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Vecchini F, Haupert G, Baudry A, Mancini J, Dumur L, Martinez R, Piquet P, Picquet J, Gaudry M. Risk Factors for Incomplete Aortic Remodeling With Stent-Assisted Balloon-Induced Intimal Disruption and Relamination in Aortic Dissection Repair for Complicated Aortic Dissection: Results of a Multicenter Study. J Endovasc Ther 2024; 31:69-79. [PMID: 35880296 DOI: 10.1177/15266028221111984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The STABILISE technique has extended the treatment of aortic dissection to the thoracoabdominal aorta to achieve complete aortic remodeling. The aim of this multicenter study was to analyze the short- and midterm anatomical results of the STABILISE technique. MATERIALS AND METHODS We retrospectively analyzed patients treated with the STABILISE technique for complicated aortic dissection at 3 French academic centers. The aortic diameter at different levels was measured preoperatively, postoperatively, and at 1 year. RESULTS Between 2018 and 2020, 58 patients, including 47 men (average patient age: 60±11 years), were treated for type B aortic dissection in 34 cases and residual aortic dissection after type A repair in 24 cases. Three (5.2%) patients died postoperatively. Complete aortic remodeling (false lumen thrombosis and complete reapposition of the intimal flap) was achieved in 45/55 patients (81.8%), and false lumen thrombosis in the thoracic aorta was achieved in 52/55 patients (94.5%). At 1 year, with a computed tomographic (CT) scan available for 98.2% (54/55) of patients, we observed a significant decrease in the maximal thoracic aortic diameter and a significant increase in the aortic diameter at the bare-stent level compared with the preoperative CT scan. Severe aortic angulation (p=0.024) was a risk factor for incomplete aortic remodeling and significantly increased the aortic diameter (p=0.032). Chronic aortic dissection was associated with an increased risk of incomplete aortic remodeling (p=0.002). CONCLUSIONS STABILISE for complicated aortic dissection results in false lumen thrombosis, complete reapposition of the intimal flap, and a decrease in the maximum aortic diameter in most cases. Incomplete reapposition of the intimal flap, which is more frequent in cases of chronic aortic dissection and severe aortic angulation, is a risk factor for a significant increase in the aortic diameter at the bare-stent level, and this risk justifies close follow-up and better patient selection. CLINICAL IMPACT STABILISE technique for complicated aortic dissection results in false lumen thrombosis, complete aortic remodeling and a decrease in the maximum aortic diameter in most cases. At the bare-stent level, incomplete reapposition of the intimal flap, more frequent in chronic aortic dissection and severe aortic angulation, is a risk factor for an increased aortic diameter. This finding justifies close follow-up and better patient selection; thus, the STABILISE technique should be used with care in chronic aortic dissection and severe aortic angulation.
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Affiliation(s)
- Fabien Vecchini
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France
- Aortic Center, APHM, Timone Hospital, Marseille, France
| | - Gautier Haupert
- Department of Vascular Surgery, Tours Academic Center, Tours, France
| | - Anna Baudry
- Department of Vascular Surgery, Angers Academic Center, Angers, France
| | - Julien Mancini
- APHM, INSERM, IRD Biostatistics Department, SESSTIM, BIOSTIC, Aix-Marseille University, Marseille, France
| | - Lucie Dumur
- Department of Vascular Surgery, Tours Academic Center, Tours, France
| | - Robert Martinez
- Department of Vascular Surgery, Tours Academic Center, Tours, France
| | - Philippe Piquet
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France
- Aortic Center, APHM, Timone Hospital, Marseille, France
| | - Jean Picquet
- Department of Vascular Surgery, Angers Academic Center, Angers, France
| | - Marine Gaudry
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France
- Aortic Center, APHM, Timone Hospital, Marseille, France
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Liu L, Wu X, Li S, Li Y, Tan S, Bai Y. Solving the class imbalance problem using ensemble algorithm: application of screening for aortic dissection. BMC Med Inform Decis Mak 2022; 22:82. [PMID: 35346181 PMCID: PMC8962101 DOI: 10.1186/s12911-022-01821-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Imbalance between positive and negative outcomes, a so-called class imbalance, is a problem generally found in medical data. Despite various studies, class imbalance has always been a difficult issue. The main objective of this study was to find an effective integrated approach to address the problems posed by class imbalance and to validate the method in an early screening model for a rare cardiovascular disease aortic dissection (AD). Methods Different data-level methods, cost-sensitive learning, and the bagging method were combined to solve the problem of low sensitivity caused by the imbalance of two classes of data. First, feature selection was applied to select the most relevant features using statistical analysis, including significance test and logistic regression. Then, we assigned two different misclassification cost values for two classes, constructed weak classifiers based on the support vector machine (SVM) model, and integrated the weak classifiers with undersampling and bagging methods to build the final strong classifier. Due to the rarity of AD, the data imbalance was particularly prominent. Therefore, we applied our method to the construction of an early screening model for AD disease. Clinical data of 523,213 patients from the Institute of Hypertension, Xiangya Hospital, Central South University were used to verify the validity of this method. In these data, the sample ratio of AD patients to non-AD patients was 1:65, and each sample contained 71 features. Results The proposed ensemble model achieved the highest sensitivity of 82.8%, with training time and specificity reaching 56.4 s and 71.9% respectively. Additionally, it obtained a small variance of sensitivity of 19.58 × 10–3 in the seven-fold cross validation experiment. The results outperformed the common ensemble algorithms of AdaBoost, EasyEnsemble, and Random Forest (RF) as well as the single machine learning (ML) methods of logistic regression, decision tree, k nearest neighbors (KNN), back propagation neural network (BP) and SVM. Among the five single ML algorithms, the SVM model after cost-sensitive learning method performed best with a sensitivity of 79.5% and a specificity of 73.4%. Conclusions In this study, we demonstrate that the integration of feature selection, undersampling, cost-sensitive learning and bagging methods can overcome the challenge of class imbalance in a medical dataset and develop a practical screening model for AD, which could lead to a decision support for screening for AD at an early stage.
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Hsu HL, Huang CY, Lu HY, Hsu CP, Chen PL, Chen IM, Shih CC. Aortic remodeling of the provisional extension to induce complete attachment technique in DeBakey type IIIb aortic dissection. J Formos Med Assoc 2022; 121:1748-1757. [DOI: 10.1016/j.jfma.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/26/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022] Open
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Nassib J, Hireche K, Ozdemir BA, Alric P, Canaud L. Fate of the Dissected Thoraco-Abdominal Aorta Distal to TEVAR (Thoracic Endovascular Aortic Repair) for Complicated Acute and Subacute Type B Aortic Dissection. J Endovasc Ther 2021; 29:773-779. [PMID: 34955055 DOI: 10.1177/15266028211065964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study assessed morphological changes in the aortic true and false lumens during follow-up of patients undergoing TEVAR (Thoracic Endovascular Aortic Repair) for complicated acute and subacute type B dissection. The study analyzes the effectiveness of TEVAR in preventing distal aneurysmal progression. MATERIALS AND METHODS All patients between 2009 and 2019 undergoing TEVAR for complicated acute and subacute type B dissection at the study institution were retrospectively reviewed. Maximal diameters were measured on the proximal descending aorta right below the left subclavian artery, thoraco-abdominal junction right above the celiac trunk, and infrarenal aortic right above the inferior mesenteric artery, pre-operatively and during follow-up, analyzing either expansion or shrinkage of true and false lumens at these 3 sites. RESULTS Forty-one patients were included. Thirty-day incidence of death, stroke, paraplegia, and visceral ischemia was, respectively, 8% (n = 4), 6% (n = 3), 2% (n = 1), and 2% (n = 1). Three patients (6%) died from intervention-related cause. Mortality was 17% (n = 8) during a mean follow-up of 54 months. One patient had aneurysmal dilation of the descending aorta needing additional coverage and only 2 (4%) developed thoraco-abdominal aneurysms requiring re-intervention. In the remaining patients, both significant expansion of the true lumen and shrinkage of false lumen were observed at all 3 sites. CONCLUSION Proximal coverage of the main entry tear appears to prevent aneurysmal progression in most patients (96%). With such promising results, TEVAR should be considered as a first-line treatment in acute and subacute type B dissection.
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Affiliation(s)
- Jowan Nassib
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Kheira Hireche
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Baris Ata Ozdemir
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.,University of Bristol, Bristol, UK
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France
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Pruitt EY, Scali ST, Arnaoutakis DJ, Back MR, Arnaoutakis GJ, Martin TD, Beaver TM, Huber TS, Upchurch GR. Complicated acute type B aortic dissection: update on management and results. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:697-707. [PMID: 32964895 PMCID: PMC7796970 DOI: 10.23736/s0021-9509.20.11555-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The role of thoracic endovascular aortic repair (TEVAR) has evolved and is now firmly established as a mainstay of therapy for acute complicated type B aortic dissection (acTBAD). However, several important issues remain unresolved including the optimal timing, sizing, graft selection, coverage length and utilization of adjunctive therapies to address false lumen perfusion. Therefore, the purpose of this study was to provide a contemporary perspective on the management and results for TEVAR of acTBAD. METHODS All TEVAR patients (N.=159) with acTBAD from a single high-volume, academic medical center were analyzed. Comparative results across time-dependent cohorts (2005-2009 [N.=43] vs. 2010-2014 [N.=56] vs. 2015-2020 [N.=60]) are presented. RESULTS 30-day mortality was 13%(N.=21) with a trend towards improvement over time (2005-2009, 18% vs. 2010-2020, 12%; P=0.1). Similarly, incidence of postoperative complications also declined: 2005-2009, 70% vs. 2010-2020, 36%(P-trend=0.08). One and 2-year freedom from aorta-related reintervention was 78±7% and 73±9% and did not differ across cohorts (log-rank P=0.5). Respective one and 5-year survival was 75±3% and 64±7%, but significantly improved with time (log-rank P<0.001). The corresponding one and five-year freedom from aorta-related mortality was 82±4% and 78±7% but did not change during the study interval (log-rank P=0.3). CONCLUSIONS Outcomes for TEVAR of acTBAD continue to improve over time. This time-dependent analysis delineates how results have changed due to increasing experience, technologic evolution, and maturation of the peer reviewed evidence. These results along with the evidence-based review provided herein, provide an update on the management and results of TEVAR of acTBAD while highlighting specific controversies unique to the management of this challenging clinical problem.
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Affiliation(s)
- Eric Y Pruitt
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA -
| | - Dean J Arnaoutakis
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - Martin R Back
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
| | - George J Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL, USA
| | - Tomas D Martin
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL, USA
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL, USA
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, USA
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Wheatley GH. Commentary: The secret life of aortic dissections. J Thorac Cardiovasc Surg 2020; 160:368-369. [DOI: 10.1016/j.jtcvs.2019.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
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Qiu P, Zha B, Zhang X, Ye K, Qin J, Yang X, Peng Z, Liu J, Lu X. A meta-analysis of combined proximal stent grafting with or without adjunctive distal bare stent for the management of aortic dissection. J Vasc Surg 2020; 72:1109-1120.e6. [PMID: 32304727 DOI: 10.1016/j.jvs.2020.02.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 02/23/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The efficacy and safety of placement of a proximal covered stent graft combined with a distal bare stent are controversial because of the lack of evidence. This systematic review and meta-analysis compared the outcomes of combined proximal covered stent grafting with distal bare stenting (BS group) and proximal covered stent grafting without distal bare stenting (non-BS group). METHODS The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases and key references were searched up to January 26, 2019. Predefined outcomes of interest were mortality, morbidity, and postoperative assessment of aortic remodeling. We pooled risk ratios (RRs) of the outcomes of interest using fixed effects model or random effects model. RESULTS Overall, eight observational studies involving 914 patients were included. There were no significant differences in overall aorta-related mortality (RR, 0.54; confidence interval [CI], 0.24-1.24; P = .15), complete thoracic false lumen (FL) thrombosis rate (RR, 1.23; CI, 0.83-1.81; P = .30), or complete abdominal FL thrombosis rate (RR, 1.96; CI, 0.68-5.69; P = .21) between the BS group and the non-BS group. The BS group had a lower rate of partial thoracic FL thrombosis (RR, 0.40; CI, 0.25-0.65; P = .0002), a lower stent graft-induced new entry rate (RR, 0.08; CI, 0.02-0.41; P = .003), and a lower reintervention rate (RR, 0.42; CI, 0.26-0.69; P = .0005). CONCLUSIONS Combined proximal covered stent grafting with distal adjunctive bare stenting had the potential to reduce the partial thoracic FL thrombosis rate and the rates of stent graft-induced new entry and reintervention but was not associated with lower aorta-related mortality or the complete FL thrombosis rate. Further research with a stricter methodology is needed.
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Affiliation(s)
- Peng Qiu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Binshan Zha
- Department of Vascular and Thyroid Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinrui Yang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyou Peng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junchao Liu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Rong D, Ge Y, Liu J, Liu X, Guo W. Combined proximal descending aortic endografting plus distal bare metal stenting (PETTICOAT technique) versus conventional proximal descending aortic stent graft repair for complicated type B aortic dissections. Cochrane Database Syst Rev 2019; 2019. [PMID: 31684692 PMCID: PMC6820126 DOI: 10.1002/14651858.cd013149.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Aortic dissection is a separation of the aortic wall, caused by blood flowing through a tear in the inner layer of the aorta. Aortic dissection is an infrequent but life-threatening condition. The incidence of aortic dissection is 3 to 6 per 10,000 per year in the Western population, and can be up to 43 per 10,000 per year in the Eastern population. Over 20% of people with an aortic dissection do not reach a hospital alive. After admission, the mortality rates for people with an aortic dissection are between 10% and 20% for those who received endovascular treatment, and between 20% and 30% for those who had open surgery. Thoracic endovascular aortic repair (TEVAR) is the standard endovascular method to treat complicated type B aortic dissection (aortic dissections without involvement of the ascending aorta). Although TEVAR is less invasive than open surgery and has a better long-term aortic remodeling effect than conservative medical treatment, favourable aortic remodelling is usually limited to the thoracic aortic segment. TEVAR cannot be extended into the abdominal aorta because it could cover the ostia of the reno-visceral arteries. Thus, the abdominal aorta is still at risk of progressive aneurysmal degeneration. The PETTICOAT (provisional extension to induce complete attachment) technique, with proximal endograft and distal bare metal stent, was proposed in 2006 to address this issue. The concept of this technique was to implant a distal bare metal stent into the aortic true lumen, distal to the proximal endograft, to stabilize the distal collapsed intimal flap, while allowing blood flow to reno-visceral arteries. Therefore, the PETTICOAT technique was considered to be related to a more extensive aortic remodelling for people with type B aortic dissection, especially in the area of the abdominal aorta. However, it is still unclear whether the PETTICOAT technique is superior to standard TEVAR. OBJECTIVES To assess the effects of combined proximal descending aortic endografting plus distal bare metal stenting versus conventional proximal descending aortic stent graft repair for treating complicated type B aortic dissections. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 5 November 2018. We also undertook reference checking and citation searching to identify additional studies. SELECTION CRITERIA We considered all randomised controlled trials which compared the outcome of complicated type B aortic dissection, when treated by combined proximal descending aortic endografting plus distal bare metal stenting (PETTICOAT technique) versus conventional proximal descending aortic stent graft repair. DATA COLLECTION AND ANALYSIS Two independent review authors assessed all references identified by the Cochrane Vascular Information Specialist. We planned to undertake data collection and analysis in accordance with recommendations described in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We found no trials that met the inclusion criteria for this review. AUTHORS' CONCLUSIONS We identified no randomised controlled trials and therefore cannot draw any definite conclusion on this topic. Evidence from non-randomised studies appears to be favourable in the short-term, for combined proximal descending aortic endografting plus distal bare metal stenting (PETTICOAT technique) to solve the problem of unfavourable distal aortic remodeling. Randomised controlled trials are warranted to provide solid evidence on this topic. Evidence from cohort studies with large sample sizes would also be helpful in guiding clinical practice.
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Affiliation(s)
- Dan Rong
- Chinese PLA General Hospital, Department of Vascular and Endovascular Surgery, No 28, Fuxing Road, Haidian District, Beijing, Beijing, China, 100853
| | - Yangyang Ge
- Chinese PLA General Hospital, Department of Vascular and Endovascular Surgery, No 28, Fuxing Road, Haidian District, Beijing, Beijing, China, 100853
| | - Jie Liu
- Chinese PLA General Hospital, Department of Vascular and Endovascular Surgery, No 28, Fuxing Road, Haidian District, Beijing, Beijing, China, 100853
| | - Xiaoping Liu
- Chinese PLA General Hospital, Department of Vascular and Endovascular Surgery, No 28, Fuxing Road, Haidian District, Beijing, Beijing, China, 100853
| | - Wei Guo
- Chinese PLA General Hospital, Department of Vascular and Endovascular Surgery, No 28, Fuxing Road, Haidian District, Beijing, Beijing, China, 100853
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Spanos K, Kölbel T. Device profile of the Zenith Dissection Endovascular System for aortic dissection. Expert Rev Med Devices 2019; 16:541-548. [PMID: 31155976 DOI: 10.1080/17434440.2019.1627198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Introduction: Thoracic endovascular aortic repair has been increasingly used to treat type B aortic dissection (TBAD) when it is indicated, offering better outcome in terms of mortality and morbidity compared to open repair. Accepted goals for endovascular treatment of aortic dissections are the closure of the primary intimal entry tear, depressurization, and thrombosis of the false lumen. Areas covered: This is a descriptive review on the Zenith Dissection Endovascular System (Cook Medical Inc., Bloomington, IN) which is a modular system specifically designed to treat TBAD, consisting of a proximal component, the Zenith TX2 TAA Endovascular Graft, and a distal component, the Zenith Dissection Endovascular Stent. The distal stents are uncovered to avoid blockage of dominant spinal cord intercostal arteries and allow for the deployment of the stents across branch vessel origins as needed to treat the dissection. Expert opinion: The Zenith Dissection Endovascular System has already been used for the treatment of TBAD for the last decade mostly in experienced centers. Current evidence suggests that this is a feasible and safe technique with relative low early mortality and morbidity rates. It is important to highlight the potential benefit of Zenith Dissection Endovascular System on the remodeling the dissected aorta during the follow-up period.
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Affiliation(s)
- Konstantinos Spanos
- a German Aortic Center, Department of Vascular Medicine , University Heart Center , Hamburg , Germany
| | - Tilo Kölbel
- a German Aortic Center, Department of Vascular Medicine , University Heart Center , Hamburg , Germany
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Zha B, Xu G, Zhu H, Xie W, Zhang Z, Li Y, Qiu P. Endovascular repair of type B aortic dissection with the restrictive bare stent technique: morphologic changes, technique details, and outcomes. Ther Clin Risk Manag 2018; 14:1993-2002. [PMID: 30349278 PMCID: PMC6190631 DOI: 10.2147/tcrm.s177757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to present our experience and assess the morphologic changes of the descending aorta after the restrictive bare stent (RBS) technique in the treatment of type B aortic dissection (TBAD). Patients and methods A retrospective study was conducted of 22 consecutive patients with TBAD who underwent RBS treatment between February 2012 and June 2016. Indications for the RBS procedure included radiological evidence of true lumen (TL) compression or collapse and/or tortuosity index (TI) of the descending aorta >1.4. Technique success, descending aorta morphology, and clinical outcomes were evaluated. Results The technical success rate was 100%. Patients treated with the RBS technique were often accompanied by TL collapse (45.5%) or TI >1.4 (59.1%). One-month postoperative computed tomography angiography showed that the taper ratio, oversizing ratio of the stent graft, and TI values were significantly decreased compared with preoperative computed tomography angiography values (P<0.05). The 30-day mortality rate was 0%. In total 95.2% had a thrombosed false lumen in the segment of aortic coverage, and TL diameters were increased in 40.3%±11% (mean ± SD) and 37.5%±17.9% of patients in the thoracic and abdominal segments, respectively. During the follow-up from 16 to 64 months (33±19 months), no distal stent graft-induced new entry, endoleak, and paraplegia were observed. One patient died from rupture of a chronic TBAD with aneurysm degeneration. Conclusion Mid-term outcomes showed RBS to be a flexible and feasible approach to repair TBAD. RBS corrects the descending aorta morphology and promotes TL expansion in most patients, but the rupture of chronic TBAD with aneurysm degeneration was not prevented in all patients.
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Affiliation(s)
- Binshan Zha
- Department of General Surgery and Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei, People's Republic of China, .,Department of Vascular and Thyroid Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Geliang Xu
- Department of General Surgery and Anhui Province Key Laboratory of Hepatopancreatobiliary Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei, People's Republic of China,
| | - Huagang Zhu
- Department of Vascular and Thyroid Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Wentao Xie
- Department of Vascular and Thyroid Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Zhigong Zhang
- Department of Vascular and Thyroid Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yongsheng Li
- Department of Vascular and Thyroid Surgery, Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Peng Qiu
- Department of Vascular Surgery, Fourth Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
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Terzi F, Gianstefani S, Fattori R. Type B aortic dissection: it should be treated. J Cardiovasc Med (Hagerstown) 2018. [PMID: 29538144 DOI: 10.2459/jcm.0000000000000594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Francesca Terzi
- Cardiology and Interventional Cardiology Unit, Ospedali Riuniti Marche Nord, Pesaro, Italy
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Civilini E. PETTICOAT Technique to Prevent Distal Stent Graft-Induced New Entry Tears. Ann Thorac Surg 2017; 103:2023. [DOI: 10.1016/j.athoracsur.2016.09.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 11/28/2022]
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Pantaleo A, Jafrancesco G, Lovato L, Pacini D. Reply. Ann Thorac Surg 2017; 103:2023-2024. [PMID: 28528039 DOI: 10.1016/j.athoracsur.2016.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/18/2016] [Indexed: 10/19/2022]
Affiliation(s)
- Antonio Pantaleo
- Departments of Cardiac Surgery and Radiology, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti No 9, 40128 Bologna, Italy
| | - Giuliano Jafrancesco
- Departments of Cardiac Surgery and Radiology, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti No 9, 40128 Bologna, Italy
| | - Luigi Lovato
- Departments of Cardiac Surgery and Radiology, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti No 9, 40128 Bologna, Italy
| | - Davide Pacini
- Departments of Cardiac Surgery and Radiology, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti No 9, 40128 Bologna, Italy.
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The Impact of Intimal Tear Location and Partial False Lumen Thrombosis in Acute Type B Aortic Dissection. Ann Thorac Surg 2016; 102:1925-1932. [DOI: 10.1016/j.athoracsur.2016.05.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/22/2016] [Accepted: 05/03/2016] [Indexed: 12/28/2022]
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15
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Affiliation(s)
- Vikalp Jain
- Department of Surgery, Division of Vascular Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Mark A. Farber
- Department of Surgery, Division of Vascular Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Raghuveer Vallabhaneni
- Department of Surgery, Division of Vascular Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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Canaud L, Ozdemir BA, Alric P. The Provisional Extension To Induce Complete Attachment (PETTICOAT) technique to promote distal aortic remodelling in repair of acute DeBakey type I aortic dissection: is the best the enemy of the good? Eur J Cardiothorac Surg 2016; 50:153-4. [DOI: 10.1093/ejcts/ezv492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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18
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Huang X, Huang L, Sun L, Xu S, Xue Y, Zeng Q, Guo X, Peng M. Endovascular repair of Stanford B aortic dissection using two stent grafts with different sizes. J Vasc Surg 2015; 62:43-8. [PMID: 26115919 DOI: 10.1016/j.jvs.2015.02.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study was to introduce a novel strategy for thoracic endovascular aortic repair of Stanford B aortic dissection using two-stent graft implantation (TSI), in which the proximal stent and distal stent with different sizes are sequentially deployed, and to summarize our experience with this technique. METHODS A retrospective study was conducted of 72 consecutive patients (61 men; mean age, 55 ± 7 years; range, 41-67 years) with Stanford type B aortic dissection who underwent TSI treatment between January 2012 and May 2013. Among all patients, 43 (59.7%) involved the infrarenal aorta and 29 (40.3%) involved the whole thoracic and abdominal aorta; mean aortic involvement length was 226 ± 13 mm (range, 182-312 mm). Eight cases were for acute dissection (within 2 weeks from onset of symptoms), 11 cases were for chronic dissection (>3 months after initial dissection), and 53 cases were for subacute dissection (between 2 weeks and 3 months). Twenty-two cases (30.6%) were uncomplicated type and 50 cases (69.4%) were complicated type. Follow-up was performed postoperatively at 1 month, 6 months, and yearly thereafter. Technique success, aorta morphology, and procedure-related complications were evaluated. RESULTS Technical success was achieved in 100%; 72 pairs of stent grafts (144 thoracic stent grafts) and 10 left subclavian artery chimney stents were used. The mean aortic length coverage by the stent grafts was 197.6 ± 20.3 mm, and mean taper diameter span was 7.5 ± 1.8 mm. All patients were followed up from 6 to 16 months (mean, 10 ± 4 months); 95.8% (69 of 72) had a thrombosed false lumen in the aortic coverage, and the true lumen expanded on average 57% ± 11% (23%-100%). No significant changes were found in aortic diameters of the proximal and distal ends of the two stent grafts and the angles between centerlines of the distal end of the stent and the aorta during follow-up. Procedure-related complications included transient paraplegia (coverage of the left subclavian artery without revascularization and extensive coverage of aorta >220 mm) due to acute spinal cord ischemia (n = 1) and malapposition of the distal stent (primary tear closed, true lumen expansion led to oversize rate insufficient in distal stent diameter; n = 1). No death or malperfusion complications were observed during the perioperative period and follow-up. CONCLUSIONS Short-term outcomes showed TSI to be a flexible and effective approach to accurately repair Stanford B aortic dissection that could potentially address the limitations of currently available stent grafts. Further prospective clinical studies are warranted to evaluate its long-term efficacy.
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Affiliation(s)
- Xiaoyong Huang
- Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lianjun Huang
- Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Lizhong Sun
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shangdong Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuguo Xue
- Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qinglong Zeng
- Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xi Guo
- Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mingliang Peng
- Department of Intervention, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Faure EM, Canaud L, Cathala P, Serres I, Marty-Ané C, Alric P. Assessment of abdominal branch vessel patency after bare-metal stenting of the thoracoabdominal aorta in a human ex vivo model of acute type B aortic dissection. J Vasc Surg 2015; 61:1299-305. [DOI: 10.1016/j.jvs.2013.11.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/27/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
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20
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Abstract
A new appraisal of the management of acute aortic dissection is timely because of recent developments in diagnostic strategies (including biomarkers and imaging), endograft design, and surgical treatment, which have led to a better understanding of the epidemiology, risk factors, and molecular nature of aortic dissection. Although open surgery is the main treatment for proximal aortic repair, use of endovascular management is now established for complicated distal dissection and distal arch repair, and has recently been discussed as a pre-emptive measure to avoid late complications by inducing aortic remodelling.
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Affiliation(s)
| | - Rachel E Clough
- King's College London, Cardiovascular Imaging Department, Lambeth Wing St Thomas, London, UK
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21
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Disección de aorta tipo B: ¿debe ser todavía el tratamiento médico la mejor opción? No, el tratamiento endovascular puede ser la mejor opción. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2014.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Xie B, Qin YL, Fan YY, Jin H, Yao YY, Teng GJ, Ding W. Endovascular versus conventional medical treatment for uncomplicated acute type B aortic dissection. Hippokratia 2014. [DOI: 10.1002/14651858.cd011342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bo Xie
- Zhongda Hospital, Medical School, Southeast University; Department of Radiology, Section of Interventional Radiology and Vascular Surgery; 87 Dingjiaqiao Road Nanjing Jiangsu China 210009
| | - Yong-Lin Qin
- Zhongda Hospital, Medical School, Southeast University; Department of Radiology, Section of Interventional Radiology and Vascular Surgery; 87 Dingjiaqiao Road Nanjing Jiangsu China 210009
| | - Ying-Ying Fan
- Southeast University; Library; 2, Si Pai Lou Nanjing Jiangsu China 210096
| | - Hui Jin
- School of Public Health, Southeast University; Department of Epidemiology; 87 Dingjiaqiao Road Nanjing Jiangsu China 210009
| | - Yu-Yu Yao
- Zhongda Hospital, Medical School, Southeast University; Department of Cardiology; 87 Dingjiaqiao Road Nanjing Jiangsu China 210009
| | - Gao-Jun Teng
- Zhongda Hospital, Medical School, Southeast University; Department of Radiology, Section of Interventional Radiology and Vascular Surgery; 87 Dingjiaqiao Road Nanjing Jiangsu China 210009
| | - Wei Ding
- Zhongda Hospital, Medical School, Southeast University; Department of Radiology, Section of Interventional Radiology and Vascular Surgery; 87 Dingjiaqiao Road Nanjing Jiangsu China 210009
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Abstract
The management of type B aortic dissection is undergoing profound changes with timely TEVAR accepted as first-line strategy in the setting of complicated dissection; with recent technological advances and in experienced hands this intervention is considered safe and life-saving. With the ability to remodel the dissected aorta as a result of scaffolding even pre-emptive endovascular treatment is being considered and supported by long-term stability and often prevention of aneurysmal expansion. This insight and a growing number of silent risk conditions (resistant hypertension, partial false lumen thrombosis) may lower the threshold for TEVAR in asymptomatic patients in the subacute phase. In the chronic phase of a type B dissection patients are usually free of symptoms, however, with the expanding false lumen at risk of rupture. Advanced TEVAR options (including branches and fenestrations) are likely to be used more often than open surgical replacement of such aneurysmatic segment of the dissected aorta in that chronic phase. All dissection patients should be offered lifelong surveillance.
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Affiliation(s)
- Christoph A Nienaber
- Department of Cardiology, University Heart Centre Rostock, University of Rostock, Rostock, Germany
| | - Dimitar Divchev
- Department of Cardiology, University Heart Centre Rostock, University of Rostock, Rostock, Germany
| | | | - Rachel E Clough
- Cardiovascular Imaging Department, King's College London, London, UK
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Aortic remodeling after endovascular treatment of complicated type B aortic dissection with the use of a composite device design. J Vasc Surg 2014; 59:1544-54. [DOI: 10.1016/j.jvs.2013.12.038] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/12/2013] [Accepted: 12/13/2013] [Indexed: 11/17/2022]
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