Thoracic endovascular aortic repair with stent grafts alone or with a composite device design in patients with acute type B aortic dissection in the setting of malperfusion.

Published on Feb 1, 2020in Journal of Vascular Surgery4.268
· DOI :10.1016/J.JVS.2019.04.478
Jonathan Sobocinski26
Estimated H-index: 26
(university of lille),
Nuno Dias33
Estimated H-index: 33
+ 5 AuthorsStéphan Haulon54
Estimated H-index: 54
(University of Paris-Sud)
Sources
Abstract
Abstract Objective The objective of this study was to compare short-term outcomes in patients who underwent thoracic endovascular aortic repair (TEVAR) with stent grafts alone or with a composite device design (stent graft plus bare-metal aortic stent) for acute type B aortic dissection in the setting of malperfusion. Methods This retrospective analysis included patients with acute (≤14 days of symptom onset) complicated type B dissection in the setting of malperfusion who were treated with stent grafts alone (TEVAR cohort) at two European institutions vs those who underwent TEVAR with a composite device design (Cook Medical, Bloomington, Ind) in the investigational STABLE I feasibility study and STABLE II pivotal study (STABLE cohort). Preoperative characteristics and 30-day outcomes (including mortality, malperfusion-related mortality, morbidity, and secondary interventions) were compared between the two groups. Results The TEVAR cohort (41 patients; mean age, 58.8 ± 12.7 years; 78.0% male) and the STABLE cohort (84 patients; mean age, 57.8 ± 11.7 years; 71.4% male) were largely similar in preoperative medical characteristics, with more STABLE patients presenting with a history of hypertension (79.8% vs 58.5%; P  = .018). The TEVAR and STABLE groups had similar lengths of dissection (451.8 ± 112.7 mm vs 411.8 ± 116.4 mm; P  = .10) and similar proximal and distal extent of dissection. At presentation, the two groups exhibited comparable organ system involvement in malperfusion: renal (53.7% TEVAR, 57.1% STABLE), gastrointestinal (41.5% TEVAR, 44.0% STABLE), lower extremities (34.1% TEVAR, 52.4% STABLE), and spinal cord (9.8% TEVAR, 2.4% STABLE). The 30-day rate of all-cause mortality was 17.1% (7/41) in the TEVAR group and 8.3% (7/84) in the STABLE group ( P  = .22). The 30-day rate of malperfusion-related mortality (deaths from bowel/mesenteric ischemia or multiple organ failure) was 12% (5/41) in the TEVAR group and 2.4% (2/84) in the STABLE group ( P  = .038). The 30-day morbidity, for the TEVAR and STABLE groups, respectively, included bowel ischemia (9.8% [4/41] vs 2.4% [2/84]; P  = .09), renal failure requiring dialysis (7.3% [3/41] vs 9.5% [8/84]; P > .99), paraplegia or paraparesis (4.9% [2/41] vs 3.6% [3/84]; P  = .66), and stroke (2.4% [1/41] vs 10.7% [9/84]; P  = .16). The occurrence of 30-day secondary intervention was similar in the TEVAR and STABLE groups (7.3% [3/41] vs 7.1% [6/84]; P > .99). True lumen expansion in the abdominal aorta was significantly greater in the STABLE group. Conclusions In patients with acute type B aortic dissection in the setting of branch vessel malperfusion, the use of a composite device with proximal stent grafts and distal bare aortic stent appeared to result in lower malperfusion-related mortality than the use of stent grafts alone. The 30-day rates of morbidity and secondary interventions were similar between the groups.
References19
Newest
#1Heng-Wen Chou (NTU: National Taiwan University)H-Index: 7
#2Chih-Yang Chan (NTU: National Taiwan University)H-Index: 10
Last. I-Hui Wu (NTU: National Taiwan University)H-Index: 17
view all 7 authors...
OBJECTIVES: Patients with acute (ACTBAD) or chronic complicated Type B aortic dissection (CCTBAD) undergoing thoracic endovascular aortic repair (TEVAR) remain at high risk for late aorta-related events. Few data exist on the comparison of aortic remodelling and outcomes after TEVAR between both groups. METHODS: Forty-nine patients of TEVAR for CCTBAD (n = 26) and ACTBAD (n = 23) were retrospectively reviewed at our centre. RESULTS: The overall 30-day mortality was 4%. Cumulative freedom from al...
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#2Theodosios Bisdas (WWU: University of Münster)H-Index: 27
Last. Konstantinos P. Donas (WWU: University of Münster)H-Index: 30
view all 6 authors...
Background The aim of the study was to assess the incidence and timing of adverse events and complications occurring after endovascular treatment of type B aortic dissection (TBAD) complicated with malperfusion syndrome (MPS). Methods Twenty-eight patients with TBAD and MPS treated endovascularly at our center from January 2006 to January 2015 were evaluated through a retrospective scrutiny of the medical records. The primary end point of the study was aorta-related reintervention. The secondary...
Source
Abstract. Background: The objective was to explore the outcomes and aortic remodelling after proximal thoracic endovascular aortic repair (TEVAR) in post type B aortic dissection thoracic aneurysm with a maximal diameter ≥ 5.5cm. Patients and methods: 34 cases of type B aortic dissection thoracic aneurysm undergoing proximal TEVAR (coverage of the primary entry and the aneurysm extent) from 2008 to 2013 were retrospectively reviewed with follow-up for at least 2 years. The primary endpoints were...
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#1Jonathan SobocinskiH-Index: 26
#2Joseph V. Lombardi (Cooper University Hospital)H-Index: 14
Last. Stéphan HaulonH-Index: 54
view all 8 authors...
Objective This study compared the 12-month evolution of the aortic volume in patients who underwent thoracic endovascular aortic repair (TEVAR) with stent grafts alone or a composite device (Zenith TX2 stent graft and Zenith Dissection stent; Cook Medical, Bloomington, Ind) for acute (≤2 weeks from onset) complicated type B aortic dissection. Methods This was a retrospective analysis comparing prospectively collected data from 45 patients who underwent standard TEVAR repair at three European ins...
Source
#1Raimund Erbel (University of Duisburg-Essen)H-Index: 141
#2AboyansH-Index: 2
Last. Oliver GaemperliH-Index: 69
view all 22 authors...
Source
#1Joseph V. Lombardi (Cooper University Hospital)H-Index: 14
#2Richard P. Cambria (Harvard University)H-Index: 86
Last. Feiyi JiaH-Index: 3
view all 8 authors...
Objective The purpose of this study is to report updated clinical and aortic remodeling results from the Study for the Treatment of complicated Type B Aortic Dissection using Endoluminal repair (STABLE) trial, a prospective, multicenter study evaluating safety and effectiveness of a pathology-specific endovascular system (proximal stent graft and distal bare metal stent) for the treatment of complicated type B aortic dissection. Methods All 86 enrolled patients (mean age, 59 years; 73.3% men) we...
Source
#1Jean-Marc AlsacH-Index: 16
#2Antoine GiraultH-Index: 3
Last. Jean-Noël FabianiH-Index: 50
view all 8 authors...
Objective This study evaluated the safety and effectiveness of the Zenith Dissection Endovascular System (Cook Medical, Bloomington, Ind) in the urgent treatment of acute type B aortic dissections complicated by organ malperfusion. Methods Between June 2011 and June 2013, we prospectively enrolled all patients with acute type B dissection ( Results Fifteen patients (11 men; mean age, 60 ± 12 years) were treated in emergency procedures with a median delay of 36 hours. Malperfusions included renal...
Source
#1Colin Ryan (Cleveland Clinic)H-Index: 1
#2Lina Vargas (Cleveland Clinic)H-Index: 10
Last. Timur P. Sarac (Cleveland Clinic)H-Index: 27
view all 8 authors...
Objective Malperfusion syndrome is a known predictor of poor outcomes in acute type B dissection. We describe our experience with revascularization in the acute setting. Methods Patients undergoing intervention for ischemia complicated acute type B dissection between November 1999 and March 2011 were reviewed. Details of presenting condition, surgical intervention, and postoperative course were collected. Descriptive and inferential statistical analyses included survival and freedom from reinter...
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An expert multidisciplinary panel in the treatment of type B aortic dissection reviewed available literature to develop treatment algorithms using a consensus method. Data from 63 studies published from 2006 to 2012 were retrieved for a total of 1,548 patients treated medically, 1,706 patients who underwent open surgery, and 3,457 patients who underwent thoracic endovascular repair (TEVAR). For acute (first 2 weeks) type B aortic dissection, the pooled early mortality rate was 6.4% with medical ...
Source
#1Iden D. Andacheh (UCLA Medical Center)H-Index: 2
#2Carlos E. Donayre (UCLA Medical Center)H-Index: 34
Last. Rodney A. White (UCLA Medical Center)H-Index: 64
view all 6 authors...
Objective True and false lumen changes and patient outcomes following thoracic endovascular aortic repair (TEVAR) for patients with stable type B dissection have been described by the The Investigation of Stent Grafts in Aortic Dissection (INSTEAD) trial. However, these changes have not been described in TEVAR patients treated for complications of chronic dissection. Methods A single-institution study was conducted of 73 prospectively evaluated patients treated for complications of chronic type ...
Source
Cited By5
Newest
#1Jitao Liu (Academy of Medical Sciences, United Kingdom)H-Index: 1
#2Weijie Liu (SYSU: Sun Yat-sen University)
Last. Jianfang Luo (Academy of Medical Sciences, United Kingdom)H-Index: 12
view all 10 authors...
BACKGROUND Organ malperfusion is a lethal complication in acute type B aortic dissection (ATBAD). The aim of present study is to develop a nomogram integrated with metabolic acidosis to predict in-hospital mortality and organ malperfusion in patients with ATBAD undergoing thoracic endovascular aortic repair (TEVAR). METHODS The nomogram was derived from a retrospectively study of 286 ATBAD patients who underwent TEVAR from 2010 to 2017 at a single medical center. Model performance was evaluated ...
Source
#1Jayna J. Patel (Guy's and St Thomas' NHS Foundation Trust)
#2Piotr M. Kasprzak (University Hospital Regensburg)H-Index: 22
Last. Bijan Modarai (Guy's and St Thomas' NHS Foundation Trust)H-Index: 30
view all 18 authors...
Abstract Objective To evaluate short term outcomes related to the use of the Zenith TX2 Dissection Endovascular Graft (ZDEG) and the Zenith Dissection Bare stent (ZDES) for the treatment of Stanford type B aortic dissections. Design Retrospective multicentre case cohort study Methods Data was collated from 10 European institutions for patients with both complicated and uncomplicated type B aortic dissection treated with ZDEG and ZDES between 2011 and 2018. The primary endpoint was mortality at 3...
Source
Source
#1Peng Qiu (SJTU: Shanghai Jiao Tong University)H-Index: 3
#2Binshan Zha (Anhui Medical University)H-Index: 3
Last. Xinwu Lu (SJTU: Shanghai Jiao Tong University)H-Index: 22
view all 9 authors...
Abstract Background The efficacy and safety of combined proximal covered stent-grafting with distal bare stenting are controversial because of the lack of evidence. This systematic review and meta-analysis compares the outcomes of combined proximal covered stent-grafting with those of 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 for Controlled Trials databases and key re...
Source
#1Grace J. WangH-Index: 26
#2Benjamin M. JacksonH-Index: 20
Last. Ronald M. FairmanH-Index: 66
view all 7 authors...
OBJECTIVE Type B aortic dissection (TBAD) complicated by malperfusion carries high morbidity and mortality. The present study was undertaken to compare the characteristics of malperfusion and uncomplicated cohorts and to evaluate the long-term differences in survival using a granular, national registry. METHODS Patients with TBAD entered into the thoracic endovascular aortic repair/complex endovascular aortic repair module of the Vascular Quality Initiative from 2010 to 2019 were included. The d...
Source
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