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Kletzer J, Berger T, Domin P, Schlett CL, Kondov S, Fagu A, Eschenhagen M, Czerny M, Rylski B, Kreibich M. Ascending Geometry After Thoracic Endovascular Aortic Repair for Descending Aortic Dissection. Ann Vasc Surg 2024; 109:485-493. [PMID: 39098724 DOI: 10.1016/j.avsg.2024.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND This study aimed to assess geometry changes of the ascending aorta after thoracic endovascular aortic repair (TEVAR) for descending aortic dissection and identify potential risk factors for diameter and length change. METHODS Between April 2009 and July 2021, 102 patients were treated for acute descending aortic dissections (type B and non-A non-B) with TEVAR and were included in this analysis. Computed tomography angiographic scans were transferred to a dedicated imaging software and detailed aortic measurements (including length, diameter and area) were taken in multiplanar reconstruction postoperatively, after 6 months and annually thereafter. RESULTS Sixty-five (58%) patients were male, with a mean age of 66 (±11). Four (4%) patients were diagnosed with connective tissue disease. Before TEVAR, 79% of our patients were treated with a mean of 1.5 (±1.2) different classes of antihypertensive medications. This number rose to 98% after TEVAR and 2.7 (±1.0) different antihypertensive drugs. There was no significant change in length, diameter, cross-sectional area, or volume of the ascending aorta during the follow-up of 3 years after TEVAR. Body height was a negative predictor for mean ascending aortic diameter (P value = -0.013; B = -8.890) and mean aortic diameter at the level of the brachiocephalic trunk (P value = 0.039; B = -14.763). CONCLUSIONS Our data suggest no significant changes in the ascending aorta following TEVAR of the descending thoracic aorta during mid-term follow-up when under stringent blood pressure medication. Additionally, we did not find any modifiable risk factors for geometry parameter increase.
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Affiliation(s)
- Joseph Kletzer
- Faculty of Medicine, Department of Cardiovascular Surgery, University Hospital Freiburg Heart Centre, Freiburg, Germany, University of Freiburg, Freiburg, Germany
| | - Tim Berger
- Faculty of Medicine, Department of Cardiovascular Surgery, University Hospital Freiburg Heart Centre, Freiburg, Germany, University of Freiburg, Freiburg, Germany.
| | - Pauline Domin
- Faculty of Medicine, Department of Cardiovascular Surgery, University Hospital Freiburg Heart Centre, Freiburg, Germany, University of Freiburg, Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Medical Centre - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Stoyan Kondov
- Faculty of Medicine, Department of Cardiovascular Surgery, University Hospital Freiburg Heart Centre, Freiburg, Germany, University of Freiburg, Freiburg, Germany
| | - Albi Fagu
- Faculty of Medicine, Department of Cardiovascular Surgery, University Hospital Freiburg Heart Centre, Freiburg, Germany, University of Freiburg, Freiburg, Germany
| | - Matthias Eschenhagen
- Faculty of Medicine, Department of Cardiovascular Surgery, University Hospital Freiburg Heart Centre, Freiburg, Germany, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Faculty of Medicine, Department of Cardiovascular Surgery, University Hospital Freiburg Heart Centre, Freiburg, Germany, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Maximilian Kreibich
- Faculty of Medicine, Department of Cardiovascular Surgery, University Hospital Freiburg Heart Centre, Freiburg, Germany, University of Freiburg, Freiburg, Germany
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Zheng H, Lin D, Cheng Y, Yan C, Yu S, Li J, Cheng W. Systematic review of the effect of cerebrospinal fluid drainage on outcomes after endovascular type B aortic dissection repair. J Cardiothorac Surg 2024; 19:116. [PMID: 38475763 PMCID: PMC10935911 DOI: 10.1186/s13019-024-02603-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE The aim of the present systematic review was to determine whether prophylactic use of cerebrospinal fluid drainage (CSFD) contributes to a lower rate of spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). METHODS PubMed, Embase, Web of Science and Cochrane Library databases were systematically searched to identify all relevant studies reported before May 7, 2023. A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO registration no. CRD42023441392). The primary outcome was permanent SCI. Secondary outcomes were temporary SCI and 30-day/in-hospital mortality. The data were presented as the pooled event rates (ERs) and 95% confidence intervals (CIs). RESULTS A total of 1008 studies were screened, of which 34 studies with 2749 patients were included in the present analysis. The mean Downs and Black quality assessment score was 8.71 (range, 5-12). The pooled rate of permanent SCI with prophylactic CSFD was identical to that without prophylactic CSFD (2.0%; 95% CI, 1.0-3.0; P = 0.445). No statistically significant difference was found between the rates of permanent SCI with routine vs. selective prophylactic CSFD (P = 0.596). The pooled rate of temporary SCI was 1.0% (95% CI, 0.00-1.0%). The pooled rate for 30-day or in-hospital mortality was not significantly different (P = 0.525) in patients with prophylactic CSFD (4.0, 95% CI 2.0-6.0) or without prophylactic CSFD (5.0, 95% CI 2.0-7.0). CONCLUSIONS The systematic review has shown that prophylactic CSFD was not associated with a lower rate of permanent SCI and 30-day or in-hospital mortality after TEVAR for TBAD.
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Affiliation(s)
- Huajie Zheng
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University, No. 30, Gaotanyan Road, Shapingba District, Chongqing, 400038, P.R. China
| | - Deqing Lin
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University, No. 30, Gaotanyan Road, Shapingba District, Chongqing, 400038, P.R. China
| | - Yongbo Cheng
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University, No. 30, Gaotanyan Road, Shapingba District, Chongqing, 400038, P.R. China
| | - Chaojun Yan
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University, No. 30, Gaotanyan Road, Shapingba District, Chongqing, 400038, P.R. China
| | - Sanjiu Yu
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University, No. 30, Gaotanyan Road, Shapingba District, Chongqing, 400038, P.R. China
| | - Jun Li
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University, No. 30, Gaotanyan Road, Shapingba District, Chongqing, 400038, P.R. China.
| | - Wei Cheng
- Department of Cardiac Surgery, Southwest Hospital, Third Military Medical University (Army Medical University, No. 30, Gaotanyan Road, Shapingba District, Chongqing, 400038, P.R. China.
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Frisiras A, Giannas E, Bobotis S, Kanella I, Arjomandi Rad A, Viviano A, Spiliopoulos K, Magouliotis DE, Athanasiou T. Comparative Analysis of Morbidity and Mortality Outcomes in Elderly and Nonelderly Patients Undergoing Elective TEVAR: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5001. [PMID: 37568406 PMCID: PMC10420243 DOI: 10.3390/jcm12155001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/14/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE Due to an ever-increasing ageing population and limited available data around the use of thoracic endovascular aortic repair (TEVAR) in elderly patients, investigating its efficacy and safety in this age cohort is of vital importance. We thus reviewed the existing literature on this topic to assess the feasibility of TEVAR in elderly patients with severe thoracic aortic pathologies. METHODS We identified all original research studies that assessed TEVAR in elderly patients published up to 2023. Morbidity, as assessed by neurological and respiratory complications, endoleaks, and length of stay, was the primary endpoint. Short-term mortality and long-term survival were the secondary endpoints. The Mantel-Haenszel random and fixed effects methods were used to calculate the odds ratios for each outcome. Further sensitivity and subgroup analyses were performed to validate the outcomes. RESULTS Twelve original studies that evaluated elective TEVAR outcomes in elderly patients were identified. Seven studies directly compared the use of TEVAR between an older and a younger patient group. Apart from a shorter hospital stay in older patients, no statistically significant difference between the morbidity outcomes of the two different cohorts was found. Short-term mortality and long-term survival results favoured the younger population. CONCLUSIONS The present meta-analysis indicates that, due to a safe perioperative morbidity profile, TEVAR should not be contraindicated in patients based purely on old age. Further research using large patient registries to validate our findings in elderly patients with specific aortic pathologies and both elective and emergency procedures is necessary.
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Affiliation(s)
- Angelos Frisiras
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | - Emmanuel Giannas
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | - Stergios Bobotis
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | - Ilektra Kanella
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | | | - Alessandro Viviano
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London W12 0HS, UK;
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Dimitrios E. Magouliotis
- Unit of Quality Improvement, Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London W2 1NY, UK
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Kamman AV, van Bakel PAJ, Yang B, Williams DM, Kim KM, Khaja MS, Moll FL, van Herwaarden JA, Trimarchi S, Eagle KA, Eliason JL, Patel HJ. Stroke Following Thoracic Endovascular Aortic Repair: Determinants, Short and Long Term Impact. Semin Thorac Cardiovasc Surg 2023; 35:19-30. [PMID: 35091051 DOI: 10.1053/j.semtcvs.2021.08.030] [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] [Received: 08/08/2021] [Accepted: 08/18/2021] [Indexed: 11/11/2022]
Abstract
We performed a contemporary assessment of clinical and radiographic factors of stroke after thoracic endovascular aortic repair (TEVAR). Patients undergoing TEVAR from 2006 to 2017 were identified. We assessed clinical and radiographic data, including preoperative head and neck computed tomography, Doppler ultrasonography, and intraoperative angiography. Our primary outcome was stroke after TEVAR. Four hundred seventy-nine patients underwent TEVAR, mean age 68.1 ± 19.5 years, 52.6% male. Indications for TEVAR included aneurysms (n = 238, 49.7%) or dissections (n = 152, 31.7%). Ishimaru landing zones were Zone 2 (n = 225, 47.0%), Zone 3 (n = 151, 31.5%), or Zone 4 (n = 103, 21.5%). Stroke occurred in 3.8% (n = 18) of patients, with 1.9% (8) major events (modified Rankin Scale >3). Pathophysiology was predominantly embolic (n = 14), and occurred in posterior (n = 6), anterior (n = 6), or combined circulation (n = 4), and in the left hemisphere (n = 10) or bilateral (n = 6). Univariate analysis suggested use of lumbar drain (33.3% versus 57.2%, P = 0.04), inability to revascularize the left subclavian artery (16.7% vs 5.2%, P = 0.04) and number of implanted components (2.5 ± 1.2 vs 2.0 ± 0.97, P = 0.03) were associated with stroke. Multivariable analysis identified number of implanted components (OR 1.7, 95%CI 1.17-2.67 P = 0.00) and inability to revascularize the left subclavian artery as independent predictors of stroke. Stroke was associated with a higher perioperative mortality (27.8% vs 3.9%, P < 0.01). Stroke after TEVAR is primarily embolic in nature and related to both anatomic and procedural factors. This may have important implications for device development in the era of endovascular arch repair.
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Affiliation(s)
- Arnoud V Kamman
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy; Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Pieter A J van Bakel
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Bo Yang
- Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - David M Williams
- Department of Radiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Karen M Kim
- Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Minhaj S Khaja
- Department of Radiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy
| | - Kim A Eagle
- Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Jonathan L Eliason
- Department of Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Himanshu J Patel
- Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan.
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Gyi R, Cho BC, Hensley NB. Patient Blood Management in Vascular Surgery. Anesthesiol Clin 2022; 40:605-625. [PMID: 36328618 DOI: 10.1016/j.anclin.2022.08.007] [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: 06/16/2023]
Abstract
Patient blood management (PBM) is an evidence-based, multidisciplinary approach aimed at appropriately allocating blood products to patients requiring transfusion while simultaneously minimizing inappropriate transfusions. The 3 pillars of patient blood management are optimizing erythropoiesis, minimizing blood loss, and optimizing physiological reserve of anemia. Benefits seen from PBM include limiting hospital costs and mitigating harm from numerous risks of transfusion.
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Affiliation(s)
- Richard Gyi
- Department of Anesthesiology, Johns Hopkins Hospital, 1800 Orleans Avenue, Zayed Tower 6212, Baltimore, MD 21287, USA
| | - Brian C Cho
- Department of Anesthesiology, Johns Hopkins Hospital, 1800 Orleans Avenue, Zayed Tower 6212, Baltimore, MD 21287, USA; Division of Cardiothoracic Anesthesiology, Johns Hopkins University School of Medicine, 1800 Orleans Avenue, Zayed Tower 6212, Baltimore, MD 21287, USA
| | - Nadia B Hensley
- Division of Cardiothoracic Anesthesiology, Johns Hopkins University School of Medicine, 1800 Orleans Avenue, Zayed Tower 6212, Baltimore, MD 21287, USA.
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Successful liver and kidneys transplant following aortic dissection and subclavian artery rupture: A case report. Int J Surg Case Rep 2022; 98:107526. [PMID: 35988503 PMCID: PMC9420505 DOI: 10.1016/j.ijscr.2022.107526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/14/2022] [Accepted: 08/14/2022] [Indexed: 11/22/2022] Open
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7
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MacGillivray TE, Gleason TG, Patel HJ, Aldea GS, Bavaria JE, Beaver TM, Chen EP, Czerny M, Estrera AL, Firestone S, Fischbein MP, Hughes GC, Hui DS, Kissoon K, Lawton JS, Pacini D, Reece TB, Roselli EE, Stulak J. The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection. J Thorac Cardiovasc Surg 2022; 163:1231-1249. [PMID: 35090765 DOI: 10.1016/j.jtcvs.2021.11.091] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 01/16/2023]
Affiliation(s)
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Tex
| | | | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Md
| | - Davide Pacini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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MacGillivray TE, Gleason TG, Patel HJ, Aldea GS, Bavaria JE, Beaver TM, Chen EP, Czerny M, Estrera AL, Firestone S, Fischbein MP, Hughes GC, Hui DS, Kissoon K, Lawton JS, Pacini D, Reece TB, Roselli EE, Stulak J. The Society of Thoracic Surgeons/American Association for Thoracic Surgery Clinical Practice Guidelines on the Management of Type B Aortic Dissection. Ann Thorac Surg 2022; 113:1073-1092. [PMID: 35090687 DOI: 10.1016/j.athoracsur.2021.11.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | | | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Davide Pacini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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Hl L, Yc C, Hy J, Sw C. Methods and outcomes of endovascular false lumen embolization for thoracic aortic dissection. Ann Vasc Surg 2022; 85:371-382. [PMID: 35339592 DOI: 10.1016/j.avsg.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/08/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To provide a contemporary review on endovascular false lumen (FL) embolization for thoracic aortic dissection (AD) and evaluate its early outcome. METHODS A systematic literature review on FL embolization for thoracic AD from January 2003 to December 2020 was performed under the instruction of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Each article was analyzed using a standardized protocol including predefined demographic characteristics, perioperative mortality and major complications. RESULTS A total of 29 papers with 229 patients were included into the analysis. The methods of FL occlusion used were: the Candy-Plug technique, the knickerbocker technique, the "cork in the bottleneck" technique and direct FL embolization with combination of stent-grafts, coils, onyx, plugs and glue. FL embolization procedure was performed in 79 patients (34.5%) with type A AD and 150 (65.5%) with type B AD. FL direct embolization was the most frequently used technique, and it was applied in 198 (86.5%) patients. Candy-plug, knickerbocker and "cork in the bottleneck" techniques were used in 26 (11.4%), 3 (1.3%) and 2 (0.9%) patients, respectively. Technical success was achieved in all patients except one (228/229, 99.6%) in which implantation of a stent to celiac trunk was not possible. There were four hospital deaths (1.7%). Neurological complications occurred in 6 patients (2.6%), including 4 (1.7%) spinal cord ischemia and 2 (0.9%) ischemic stroke. There were 1 (0.4%) iatrogenic retrograde dissection and 2 (0.9%) renal failure reported. The mean duration of follow-up was 16.5 months. There were 21 deaths (9.3%) during follow-up, and 8 (3.6%) were aorta-related. Thirty-three (14.7%) secondary intervention were performed. Five patients (2.2%) required open completion thoracoabdominal procedure incorporating the stent-graft into the repair. Complete FL thrombosis was observed in 181 (80.4%) patients, 34 (15.1%) had partial thrombosis, and 10 (4.4%) had FL progression. CONCLUSIONS FL embolization of the distal thoracic aorta is a promising technique in a group of patients to promote FL thrombosis and aortic remodeling in thoracic aorta.
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Affiliation(s)
- Li Hl
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong- Shenzhen Hospital, Shenzhen, China
| | - Chan Yc
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong- Shenzhen Hospital, Shenzhen, China; Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14(th) Floor K Block, Queen Mary Hospital, Hong Kong, China.
| | - Jia Hy
- Department of Vascular Surgery & Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Cheng Sw
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong- Shenzhen Hospital, Shenzhen, China; Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14(th) Floor K Block, Queen Mary Hospital, Hong Kong, China
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10
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Mpody C, Cui J, Awad H, Bhandary S, Essandoh M, Harter RL, Tobias JD, Nafiu OO. Primary Stroke and Failure-to-Rescue Following Thoracic Endovascular Aortic Aneurysm Repair. J Cardiothorac Vasc Anesth 2020; 35:2338-2344. [PMID: 33358740 DOI: 10.1053/j.jvca.2020.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/10/2020] [Accepted: 11/27/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To characterize the impact, on failure to rescue, of cerebrovascular accident as a first postoperative complication after thoracic endovascular aortic aneurysm repair (TEVAR). DESIGN A retrospective cohort study using of National Surgical Quality Improvement Program Participants User File. SETTING United States hospitals taking part in the National Surgical Quality Improvement Program. PARTICIPANTS Patients >18 years, who underwent TEVAR for nonruptured thoracic aortic aneurysm between 2005 and 2018, and developed one or more major postoperative complications within 30 days after surgery. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Out of 3,937 patients who underwent TEVAR for nonruptured thoracic aneurysm, 1,256 (31.9%) developed major postoperative complications (stroke incidence: 11.4% [143/1256]). In adults <65 years old, the occurrence of stroke as the primary complication, relative to the occurrence of other complications, was associated with ten times greater risk of failure to rescue (29.4% v 4.6%; odds ratio [OR]: 10.10; 95% confidence interval [CI] 2.45-41.56; p < 0.001). The effect size was relatively lower when stroke occurred but was not the primary complication (20.0% v 4.6%; OR: 7.55; 95% CI 1.37-41.71; p = 0.020). In patients ≥65 years, the occurrence of stroke as the primary complication did not carry the similar prognostic value. CONCLUSION Younger patients who developed stroke were up to ten times more likely to die, relative to patients who developed other major complications. Survival was substantially reduced when stroke was the primary complication. The authors' findings imply that to maximize the survival of patients undergoing TEVAR, efforts may be needed to predict and prevent stroke occurrence as a primary postoperative morbidity event.
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Affiliation(s)
- Christian Mpody
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Jerry Cui
- Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH
| | - Hamdy Awad
- Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH
| | - Sujatha Bhandary
- Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH
| | - Michael Essandoh
- Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH
| | - Ronald L Harter
- Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Olubukola O Nafiu
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH.
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Commentary: Are the early benefits of thoracic endovascular aortic repair in complicated type B dissection durable through time? J Thorac Cardiovasc Surg 2020; 163:550-551. [DOI: 10.1016/j.jtcvs.2020.04.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 11/18/2022]
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