1
|
Williams ML, de Boer M, Hwang B, Wilson B, Brookes J, McNamara N, Tian DH, Shiraev T, Preventza O. Thoracic endovascular repair of chronic type B aortic dissection: a systematic review. Ann Cardiothorac Surg 2022; 11:1-15. [PMID: 35211380 PMCID: PMC8807414 DOI: 10.21037/acs-2021-taes-25] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/04/2021] [Indexed: 04/12/2024]
Abstract
BACKGROUND At present, the optimal management strategy for chronic type B aortic dissection (CTBAD) remains unknown, as equipoise remains regarding medical management versus endovascular treatment versus open surgery. However, the results over recent years of thoracic endovascular aortic repair (TEVAR) in CTBAD appear promising. The aim of this systematic review was to provide a comprehensive analysis of the available data reporting outcomes and survival rates for TEVAR in CTBAD. METHODS Electronic searches of six databases were performed from inception to April 2021. All studies reporting outcomes, specifically 30-day mortality rates, for endovascular repair of CTBAD were identified. Relevant data were extracted, and a random-effects meta-analysis of proportions or means was performed to aggregate the data. Survival data were pooled using data derived from original Kaplan-Meier curves, which allows reconstruction of individual patient data. RESULTS Forty-eight studies with 2,641 patients were identified. Early (<30 days) all-cause and aortic-related mortality rates were low at 1.6% and 0.5%, respectively. Incidence of retrograde type A dissection in the post-operative period was only 1.4%. There were also low rates of cerebrovascular accidents and spinal cord injury (1.1% and 0.9%, respectively). Late follow-up all-cause mortality was 8.0%, however, late aortic-related mortality was only 2.4%. Reintervention rates were 10.1% for endovascular and 6.7% for surgical reintervention. Pooled rates of overall survival at 1-, 3-, 5- and 10-year were 91.5%, 84.7%, 77.7% and 56.3%, respectively. CONCLUSIONS The significant heterogeneity in the available evidence and absence of consensus reporting standards are important considerations and concern when interpreting the data. Evaluation of the evidence suggests that TEVAR for CTBAD is a safe procedure with low rates of complications. However, the optimal treatment strategy for CTBAD remains debatable and requires further research. Evidence from high-quality registries and clinical trials are required to address these challenges.
Collapse
Affiliation(s)
- Michael L. Williams
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Madeleine de Boer
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Bridget Hwang
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Bruce Wilson
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - John Brookes
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
- Department of Cardiothoracic Surgery, University Hospital Geelong, Geelong, Australia
| | - Nicholas McNamara
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - David H. Tian
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia
| | - Timothy Shiraev
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA
| |
Collapse
|
2
|
Hynes N, Berguer R, Parodi JC, Acharya Y, Sultan S. Management of complicated aortic dissection: natural history, translational research, simulation, bioconvergence, clinical evidence and literature review. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.20.01473-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
3
|
Sultan S, Barrett N, Kamal MH, Tawfick W, Atteia EM, Clarkson K, Alawy M, Hynes N. Staged Hybrid Single Lumen Reconstruction (TIGER) in Management of Chronic Symptomatic Complex Type B Aortic Dissection, Techniques, and Literature Review. Ann Vasc Surg 2020; 65:261-270. [PMID: 32007594 DOI: 10.1016/j.avsg.2019.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/03/2019] [Accepted: 12/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Endovascular intervention for chronic symptomatic type B aortic dissection (CS-TBAD) induces aortic wall stress with negative hemodynamic cardiovascular consequences. CS-TBAD risks increased morbidity and mortality due to septum maturation with significant impact on false lumen modulation, and partial lumen thrombosis conveying the worst outcome. The aim of the TIGER technique is total aortic remodeling with true lumen expansion, false lumen regression and complete thrombosis, and stabilization of overall aortic diameter. METHODS We report 5 cases of aortic dissection with a mean follow-up of 16 months (6-28 months). All had aneurysmal dilation, with 3 having acute pan aortic dissection and 2 having CS-TBAD. All were managed by sTaged HybrId sinGle lumEn Reconstruction (TIGER). Our first approach was to create one single lumen from the supraceliac, infradiaphragmatic aorta to both common iliac arteries with open surgical patching of the visceral arteries; then, we performed a TEVAR 3 months later. RESULTS Three patients required a left subclavian artery chimney graft and one required bilateral subclavian to carotid artery transposition. No spinal drainage was required, and all patients had intraoperative transesophageal echo for wire guidance. We had no aortic rupture or retrograde type A dissection, and we experienced no renal, visceral, cardiac, pulmonary, or spinal complications. All patients, but one, went off their antihypertensive medication. All patients had normal estimated glomerular filtration rate postoperatively, and they all demonstrated accelerated aortic modulation. CONCLUSIONS TIGER was not only effective at the semiacute stage to initiate remodeling and prevent malperfusion, it also facilitated a straightforward TEVAR at stage 2, which was made easier by avoiding visceral branch stenting. Moreover, it decreased the length of aortic segment, which was stented, thereby avoiding critical shattering, branch dislodgment, and visceral compromise; spinal ischemia; and negative cardiovascular consequences.
Collapse
Affiliation(s)
- Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland; Galway Clinic, Royal College of Surgeons of Ireland/ National University of Ireland Affiliated Teaching Hospitals, Galway, Ireland.
| | - Nora Barrett
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Mohamed Hatem Kamal
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Wael Tawfick
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Emad Magdy Atteia
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Kevin Clarkson
- Galway Clinic, Royal College of Surgeons of Ireland/ National University of Ireland Affiliated Teaching Hospitals, Galway, Ireland; Department of Anaesthesia, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Mahmoud Alawy
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Niamh Hynes
- Galway Clinic, Royal College of Surgeons of Ireland/ National University of Ireland Affiliated Teaching Hospitals, Galway, Ireland
| |
Collapse
|
4
|
Famularo M, Meyermann K, Lombardi JV. Aneurysmal degeneration of type B aortic dissections after thoracic endovascular aortic repair: A systematic review. J Vasc Surg 2017; 66:924-930. [DOI: 10.1016/j.jvs.2017.06.067] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/15/2017] [Indexed: 11/16/2022]
|
5
|
Nathan DP, Shalhub S, Tang GL, Sweet MP, Verrier ED, Tran NT, Aldea GS, Starnes BW. Outcomes after stent graft therapy for dissection-related aneurysmal degeneration in the descending thoracic aorta. J Vasc Surg 2015; 61:1200-6. [DOI: 10.1016/j.jvs.2014.12.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/08/2014] [Indexed: 10/23/2022]
|
6
|
Andersen ND, Keenan JE, Ganapathi AM, Gaca JG, McCann RL, Hughes GC. Current management and outcome of chronic type B aortic dissection: results with open and endovascular repair since the advent of thoracic endografting. Ann Cardiothorac Surg 2014; 3:264-74. [PMID: 24967165 DOI: 10.3978/j.issn.2225-319x.2014.05.07] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/20/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment for chronic type B aortic dissection (CTBAD) at our institution. However, it remains incapable of treating all patients with CTBAD. The present study aims to review our contemporary results with open and endovascular CTBAD repairs since the advent of thoracic endografting. METHODS The records of all patients undergoing index repair of CTBAD (chronic DeBakey type IIIA, IIIB and repaired type I) at our institution between June 2005 and December 2013, were retrospectively reviewed. RESULTS A total of 107 patients underwent CTBAD repair, of whom 70% (n=75) underwent endovascular-based procedures [44 TEVAR, 27 hybrid arch and four hybrid thoracoabdominal aortic aneurysm (TAAA) repair] and 30% (n=32) underwent open procedures (nine open descending and 23 open TAAA). Connective tissue disease (CTD), prior aortic surgery and DeBakey dissection type were strongly associated with the choice of operation. The rates of stroke, paraplegia and operative mortality following endovascular-based repairs were 0%, 0% and 4% (n=3), respectively. Adverse neurologic events were higher following open repair, and rates of stroke, paraplegia, and operative mortality were 16% (n=5), 9% (n=3), and 6% (n=2), respectively. However, 1- and 5-year survival rates were similar for endovascular-based repairs (86% and 65%, respectively), and open repairs (88% and 79%, respectively). Over a median follow-up interval of 34 months, the rate of descending aortic reintervention was 24% (n=18) following endovascular-based repairs and 0% following open repairs (P=0.001). Forty-four percent (n=8) of descending aortic reinterventions were required to treat stent graft complications (five endoleak, two stent graft collapse and one stent graft-induced new entry tear) and the remainder were required to treat metachronous pathology (n=2) or progressive aneurysmal disease related to persistent distal fenestrations (n=8). CONCLUSIONS Endovascular repair of CTBAD was associated with excellent procedural and survival outcomes, but at the expense of further reinterventions. Open repair remains relevant for patients who are not candidates for endovascular repair and was associated with higher procedural morbidity but similar overall survival and fewer reinterventions.
Collapse
Affiliation(s)
- Nicholas D Andersen
- 1 Division of Cardiovascular and Thoracic Surgery, 2 Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey E Keenan
- 1 Division of Cardiovascular and Thoracic Surgery, 2 Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Asvin M Ganapathi
- 1 Division of Cardiovascular and Thoracic Surgery, 2 Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey G Gaca
- 1 Division of Cardiovascular and Thoracic Surgery, 2 Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Richard L McCann
- 1 Division of Cardiovascular and Thoracic Surgery, 2 Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - G Chad Hughes
- 1 Division of Cardiovascular and Thoracic Surgery, 2 Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
7
|
Lee M, Lee DY, Kim MD, Lee MS, Won JY, Park SI, Yoon YN, Lee S, Choi D, Ko YG. Outcomes of Endovascular Management for Complicated Chronic Type B Aortic Dissection: Effect of the Extent of Stent Graft Coverage and Anatomic Properties of Aortic Dissection. J Vasc Interv Radiol 2013; 24:1451-60. [DOI: 10.1016/j.jvir.2013.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 06/04/2013] [Accepted: 06/05/2013] [Indexed: 11/25/2022] Open
|
8
|
Funaki B. Chronic complicated aortic dissection. J Vasc Interv Radiol 2013; 24:1460-1. [PMID: 24070503 DOI: 10.1016/j.jvir.2013.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 06/12/2013] [Indexed: 11/25/2022] Open
Affiliation(s)
- Brian Funaki
- Vascular and Interventional Radiology, University of Chicago Medicine, 5840 S. Maryland Avenue, MC 2026, Chicago, IL 60637.
| |
Collapse
|
9
|
Human ex-vivo model of Stanford type B aortic dissection. J Vasc Surg 2013; 60:767-75. [PMID: 24060393 DOI: 10.1016/j.jvs.2013.06.083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/19/2013] [Accepted: 06/29/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To report a new human ex vivo model of type B aortic dissection (TBAD) and to assess if the locations of the primary entry tear determine the patterns of dissection propagation. METHODS Twenty fresh human aortas were harvested. TBADs were surgically initiated 2 cm below the left subclavian artery at four different locations (lateral, n = 5; medial, n = 5; anterior, n = 5; posterior, n = 5). Aortas were thereafter connected to a bench-top pulsatile flow model to induce antegrade propagation of the dissection. RESULTS Antegrade propagation of the dissection was achieved and reached at least the celiac trunk (CT) in all the cases. Dissection was propagated to the renal aorta in 16 (80%) and infrarenal aorta in seven cases (35%). Left renal artery with or without the CT originated more often from the false channel when primary entry tear was lateral. Right renal artery and the CT most often originated from the false channel when primary entry tear was medial. When the CT was the only one originating from the false channel, primary entry tear was more often anterior, whereas when it originated from the true channel, it was more often posterior. CONCLUSIONS This human ex vivo model of TBAD is reproducible, since, in all the aortas, extended dissection was achieved and provides the first model of human aortic dissection with infrarenal aorta extension allowing future assessment of endovascular devices developed for human use. Furthermore, it allows clarification of the patterns of aortic dissection propagation and visceral and renal artery involvement according to the site of the primary entry tear.
Collapse
|
10
|
Chad Hughes G, Andersen ND, McCann RL. Endovascular Repair of Chronic Type B Aortic Dissection With Aneurysmal Degeneration. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.optechstcvs.2013.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
11
|
Oderich GS, Mendes BC. Commentary: Chronic Aortic Dissections and a New Frontier: Fenestrated and Branched Endografts. J Endovasc Ther 2012; 19:350-5. [DOI: 10.1583/12-3860c.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|