A meta-analysis of combined proximal stent grafting with or without adjunctive distal bare stent for the management of aortic dissection.

Published on Sep 1, 2020in Journal of Vascular Surgery3.405
· DOI :10.1016/J.JVS.2020.02.052
Peng Qiu3
Estimated H-index: 3
(SJTU: Shanghai Jiao Tong University),
Binshan Zha3
Estimated H-index: 3
(Anhui Medical University)
+ 6 AuthorsXinwu Lu20
Estimated H-index: 20
(SJTU: Shanghai Jiao Tong University)
Sources
Abstract
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 references were searched up to 26 January 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, 8 observational studies involving 914 patients were included. There were no significant differences in overall aortic-related mortality (RR, 0.54; CI, 0.24-1.24; P=0.15), the complete thoracic false lumen (FL) thrombosis rate (RR, 1.23; CI, 0.83-1.81; P=0.30) or the complete abdominal FL thrombosis rate (RR, 1.96; CI, 0.68-5.69; P=0.21) 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=0.0002), a lower stent-graft-induced new entry (SINE) rate (RR, 0.08; CI, 0.02-0.41; P=0.003) and a lower reintervention rate (RR, 0.42; CI, 0.26-0.69; P=0.0005). 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 SINE and reintervention but was not associated with lower aortic-related mortality or the complete FL thrombosis rate. Further research with a stricter methodology is needed.
References47
Newest
#1Jonathan Sobocinski (university of lille)H-Index: 24
#2Nuno DiasH-Index: 30
Last. Stéphan Haulon (University of Paris-Sud)H-Index: 56
view all 8 authors...
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#1Elsa Madeleine Faure (University of Montpellier)H-Index: 1
#2Salma El Batti (University of Paris)H-Index: 8
Last. Jean-Marc Alsac (University of Paris)H-Index: 15
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Abstract Objectives Surgical repair in patients with acute DeBakey type I aortic dissection (ADIAD) achieves good short-term results, but in several patients the false lumen remains patent in the descending aorta because of distal intimal tears with persisting risk for distal aneurismal evolution. We report the short- and mid-term outcomes of the stent-assisted balloon-induced intimal disruption and relamination of aortic dissection (STABILISE) technique for the 16 first patients treated for a r...
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#1Dhaval Desai (UW: University of Wisconsin-Madison)H-Index: 2
#2William R. Miranda (Mayo Clinic)H-Index: 14
Last. A. Jamil Tajik (UW: University of Wisconsin-Madison)H-Index: 15
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#1Luca BertoglioH-Index: 23
#2Enrico RinaldiH-Index: 11
Last. Roberto ChiesaH-Index: 46
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INTRODUCTION: A systematic literature search on outcomes of the PETTICOAT technique was aimed at verifying the feasibility and safety of the procedure, comparing clinical outcomes with standard stent-grafting of the proximal entry tear as well as describing the possible benefits in terms of aortic remodeling. EVIDENCE ACQUISITION: Potentially eligible papers were sought through a computerized search of MEDLINE and SCOPUS databases between January 2006 and June 2016. Key words used for potentiall...
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#1Ibrahim Sultan (University of Pittsburgh)H-Index: 20
#2Keith Dufendach (University of Pittsburgh)H-Index: 4
Last. Thomas G. Gleason (University of Pittsburgh)H-Index: 50
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#1Binshan Zha (Anhui Medical University)H-Index: 3
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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 tor...
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Objectives This article reports mid-term results of 41 patients treated by the stent assisted balloon induced intimal disruption and relamination (STABILISE) technique for acute type B aortic dissection. Methods Between November 2011 and November 2017, 41 patients (10 male; median age 50 years) underwent proximal descending aortic stent grafting plus stent assisted balloon induced intimal disruption of the thoraco-abdominal aorta for acute type B aortic dissection. Serial computed tomography ang...
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#1Arturo EvangelistaH-Index: 61
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Acute aortic dissection (AAD) is a life-threatening condition associated with high morbidity and mortality rates, and it remains a challenge to diagnose and treat. The International Registry of Acute Aortic Dissection was established in 1996 with the mission to raise awareness of this condition and provide insights to guide diagnosis and treatment. Since then, >7300 cases have been included from >51 sites in 12 countries. Although presenting symptoms and physical findings have not changed signif...
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