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DOI: 10.1055/s-0034-1370760
TEVAR for Symptomatic Stanford B Dissection: A Systematic Review of 30-Day Mortality and Morbidity
Publikationsverlauf
11. August 2013
18. Dezember 2013
Publikationsdatum:
21. April 2014 (online)
![](https://www.thieme-connect.de/media/thoracic/201502/lookinside/thumbnails/10.1055-s-0034-1370760-1.jpg)
Abstract
Background The aim of this study was to determine morbidity and 30-day mortality rates of thoracic endovascular aortic repair (TEVAR) for Stanford B dissection over a 16-year period and determine if these rates have improved with better stent-graft technology and surgical technique.
Methods Electronic databases were searched in all languages and a systematic review conducted. A comparison of the early (1998–2007 = 787 patients) and later (2007–2013 = 787 patients) halves of the patient population was done. Studies were chosen based on availability of details regarding morbidity and mortality. Ambiguous studies were excluded.
Results A total of 69 suitable studies published between 1998 and 2013 (1,574 patients) were examined including 1 randomized control trial, 55 retrospective studies, 3 prospective, 1 mixed, and 9 case reports. Overall mortality and morbidity rates for TEVAR was 8.07% (n = 127) and 30.8% (n = 485), respectively. The stent-graft–related death rate was 6.20% (97 cases excluding medically related deaths). The endoleak rate was 5.9% of which most were type I. Major complications include stroke (2.7%), paraplegia (1.9%), partial thrombosis of false lumen (2.5%), retrograde type A dissection (3.1%), visceral malperfusion (2.0%), conversion to open intervention (1.9%), and secondary intervention (4.1%). The stent-graft–related mortality rate increased in the 2007 to 2013 group compared with the 1998 to 2007 group (56.2 vs. 24% of patients who died; p < 0.05). There was also an increase in the overall morbidity rates from 25% (1998–2007) to 36.6% (2007–2013) but did not reach statistical significance p > 0.05.
Conclusion Mortality and morbidity rates for TEVAR seemed to have increased over the past 16 years despite improved technology and surgical technique. This may be explained by the increasing liberal use of TEVAR intervention and quite possibly better reporting. The current data are highly heterogenous making it difficult for solid conclusions to be drawn. The only way forward is through better data registries and well-designed clinical trials.
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References
- 1 Dotter CT, Judkins MP. Transluminal treatment of atherosclerotic obstruction: description of a new technique and preliminary report of this application. Circulation 1964; 30: 654-670
- 2 Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991; 5 (6) 491-499
- 3 Eggebrecht H, Nienaber CA, Neuhäuser M , et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J 2006; 27 (4) 489-498
- 4 Walsh SR, Tang TY, Sadat U , et al. Endovascular stenting versus open surgery for thoracic aortic disease: systematic review and meta-analysis of perioperative results. J Vasc Surg 2008; 47 (5) 1094-1098
- 5 Xiong J, Jiang B, Guo W, Wang SM, Tong XY. Endovascular stent graft placement in patients with type B aortic dissection: a meta-analysis in China. J Thorac Cardiovasc Surg 2009; 138 (4) 865-872
- 6 Zhang H, Wang ZW, Zhou Z, Hu XP, Wu HB, Guo Y. Endovascular stent-graft placement or open surgery for the treatment of acute type B aortic dissection: a meta-analysis. Ann Vasc Surg 2012; 26 (4) 454-461
- 7 Nienaber CA, Rousseau H, Eggebrecht H , et al; INSTEAD Trial. Randomized comparison of strategies for type B aortic dissection: the INvestigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial. Circulation 2009; 120 (25) 2519-2528
- 8 Nienaber CA, Kische S, Akin I , et al. Strategies for subacute/chronic type B aortic dissection: the Investigation Of Stent Grafts in Patients with type B Aortic Dissection (INSTEAD) trial 1-year outcome. J Thorac Cardiovasc Surg 2010; 140 (6) S101-S108 , discussion S142–S146
- 9 Fattori R, Montgomery D, Lovato L , et al. Survival after endovascular therapy in patients with type B aortic dissection: a report from the International Registry of Acute Aortic Dissection (IRAD). JACC Cardiovasc Interv 2013; 6 (8) 876-882
- 10 Kische S, Ehrlich MP, Nienaber CA , et al. Endovascular treatment of acute and chronic aortic dissection: midterm results from the Talent Thoracic Retrospective Registry. J Thorac Cardiovasc Surg 2009; 138 (1) 115-124
- 11 Leurs LJ, Bell R, Degrieck Y, Thomas S, Hobo R, Lundbom J ; EUROSTAR; UK Thoracic Endograft Registry collaborators. Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries. J Vasc Surg 2004; 40 (4) 670-679 , discussion 679–680
- 12 Ahmad F, Cheshire N, Hamady M. Acute aortic syndrome: pathology and therapeutic strategies. Postgrad Med J 2006; 82 (967) 305-312
- 13 De Bakey ME, Cooley DA, Creech Jr O. Surgical considerations of dissecting aneurysm of the aorta. Ann Surg 1955; 142 (4) 586-610 , discussion, 611–612
- 14 National Institute of Clinical Excellence. Endovascular stent-graft placement in thoracic aortic aneurysms and dissections. Procedure Guidance number 127; 2005
- 15 Thrumurthy SG, Karthikesalingam A, Patterson BO , et al. A systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection. Eur J Vasc Endovasc Surg 2011; 42 (5) 632-647 Erratum in: Eur J Vasc Endovasc Surg 2012;43(5):619
- 16 Nienaber CA. Influence and critique of the INSTEAD Trial (TEVAR versus medical treatment for uncomplicated type B aortic dissection). Semin Vasc Surg 2011; 24 (3) 167-171
- 17 Fattori R, Cao P, De Rango P , et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol 2013; 61 (16) 1661-1678
- 18 Hanna JM, Andersen ND, Ganapathi AM, McCann RL, Hughes GC. Five-year results for endovascular repair of acute complicated type B aortic dissection. J Vasc Surg 2014; 59 (1) 96-106
- 19 Wilkinson DA, Patel HJ, Williams DM, Dasika NL, Deeb GM. Early open and endovascular thoracic aortic repair for complicated type B aortic dissection. Ann Thorac Surg 2013; 96 (1) 23-30 , discussion 230
- 20 Minami T, Imoto K, Uchida K , et al. Clinical outcomes of emergency surgery for acute type B aortic dissection with rupture. Eur J Cardiothorac Surg 2013; 44 (2) 360-364 , discussion 364–365
- 21 Lombardi JV, Cambria RP, Nienaber CA , et al; STABLE investigators. Prospective multicenter clinical trial (STABLE) on the endovascular treatment of complicated type B aortic dissection using a composite device design. J Vasc Surg 2012; 55 (3) 629-640 , e2
- 22 Heijmen RH, Thompson MM, Fattori R, Goktay Y, Teebken OE, Orend KH. Valiant thoracic stent-graft deployed with the new captivia delivery system: procedural and 30-day results of the Valiant Captivia registry. J Endovasc Ther 2012; 19 (2) 213-225
- 23 Mitchell ME, Rushton Jr FW, Boland AB, Byrd TC, Baldwin ZK. Emergency procedures on the descending thoracic aorta in the endovascular era. J Vasc Surg 2011; 54 (5) 1298-1302 , discussion 1302
- 24 Fioranelli A, Razuk Filho A, Castelli Júnior V, Karakhanian W, Godoy JM, Caffaro RA. Mortality within the endovascular treatment in Stanford type B aortic dissections. Rev Bras Cir Cardiovasc 2011; 26 (2) 250-257
- 25 Cambria RP, Crawford RS, Cho JS , et al; GORE TAG Investigators. A multicenter clinical trial of endovascular stent graft repair of acute catastrophes of the descending thoracic aorta. J Vasc Surg 2009; 50 (6) 1255-1264 , e1–e4
- 26 Patel HJ, Williams DM, Meerkov M, Dasika NL, Upchurch Jr GR, Deeb GM. Long-term results of percutaneous management of malperfusion in acute type B aortic dissection: implications for thoracic aortic endovascular repair. J Thorac Cardiovasc Surg 2009; 138 (2) 300-308 [Erratum in J Thorac Cardiovasc Surg 2009;138(3):794]
- 27 Day CP, Buckenham TM. Endovascular repair of the thoracic aorta: predictors of 30-day mortality in patients on the New Zealand Thoracic Aortic Stent Database (NZ TAS). Eur J Vasc Endovasc Surg 2009; 37 (2) 160-165
- 28 Porcu P, Chavanon O, Thony F, Blin D. Unusual aortic stent complication after endovascular repair of the descending thoracic aorta in type B dissection in a patient with giant-cell arteritis. Interact Cardiovasc Thorac Surg 2009; 8 (2) 287-289
- 29 Chemelli-Steingruber I, Chemelli A, Strasak A , et al. Endovascular repair or medical treatment of acute type B aortic dissection? A comparison. Eur J Radiol 2010; 73 (1) 175-180
- 30 Mastroroberto P, di Virgilio A, Renzulli A, Indolfi C. Endovascular repair of type B aortic dissection: is it possible to prevent post-procedure complications?. Eur J Cardiothorac Surg 2008; 33 (5) 945-946 , author reply 946–947
- 31 Flecher E, Cluzel P, Bonnet N , et al. Endovascular treatment of descending aortic dissection (type B): short- and medium-term results. Arch Cardiovasc Dis 2008; 101 (2) 94-99
- 32 Apple J, McQuade KL, Hamman BL, Hebeler RF, Shutze WP, Gable DR. Initial experience in the treatment of thoracic aortic aneurismal disease with a thoracic aortic endograft at Baylor University Medical Center. Proc ( Bayl Univ Med Cent) 2008; 21 (2) 115-119
- 33 Khoynezhad A, Donayre CE, Smith J, Kopchok GE, Walot I, White RA. Risk factors for early and late mortality after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg 2008; 135 (5) 1103-1109 , e1–e4
- 34 Dagenais F, Dumont E, Voisine P. Intramural hematoma of the arch and ascending aorta owing to acute aortic syndrome of the descending aorta: to stent or not to stent?. J Endovasc Ther 2008; 15 (5) 544-549
- 35 Boufi M, Hartung O, Dona B , et al. Is endovascular treatment of acute thoracic aortic disease possible in centers where extracorporal circulation is not available? [in French]. J Mal Vasc 2008; 33 (2) 72-78
- 36 Misfeld M, Sievers HH, Hadlak M, Gorski A, Hanke T. Rate of paraplegia and mortality in elective descending and thoracoabdominal aortic repair in the modern surgical era. Thorac Cardiovasc Surg 2008; 56 (6) 342-347
- 37 Hager E, Moudgill N, Lipman A, Dimuzio P, Lombardi J. Coil-assisted false lumen thrombosis in complicated chronic type B dissection. J Vasc Surg 2008; 48 (2) 465-468
- 38 Neuhauser B, Greiner A, Jaschke W, Chemelli A, Fraedrich G. Serious complications following endovascular thoracic aortic stent-graft repair for type B dissection. Eur J Cardiothorac Surg 2008; 33 (1) 58-63
- 39 Duebener L, Hartmann F, Kurowski V , et al. Surgical interventions after emergency endovascular stent-grafting for acute type B aortic dissections. Interact Cardiovasc Thorac Surg 2007; 6 (3) 288-292
- 40 Czerny M, Zimpfer D, Rodler S , et al. Endovascular stent-graft placement of aneurysms involving the descending aorta originating from chronic type B dissections. Ann Thorac Surg 2007; 83 (5) 1635-1639
- 41 Schoder M, Czerny M, Cejna M , et al. Endovascular repair of acute type B aortic dissection: long-term follow-up of true and false lumen diameter changes. Ann Thorac Surg 2007; 83 (3) 1059-1066
- 42 Sharif MA, O'Donnell ME, Blair PH, Kennedy P. Emergency endovascular repair of acute descending thoracic aortic dissection. Vasc Health Risk Manag 2007; 3 (5) 769-773
- 43 Bingol H, Iyem H, Akay HT , et al. Endovascular repair in management of thoracic aortic aneurysms. Int J Cardiovasc Imaging 2007; 23 (1) 53-59
- 44 Slovut DP, DeMaioribus CA, Konda S. Type B aortic dissection and left renal artery stenosis treated with a thoracic endoprosthesis. J Vasc Surg 2007; 45 (2) 414
- 45 Song TK, Donayre CE, Walot I , et al. Endograft exclusion of acute and chronic descending thoracic aortic dissections. J Vasc Surg 2006; 43 (2) 247-258
- 46 Kaya A, Heijmen RH, Overtoom TT, Vos JA, Morshuis WJ, Schepens MA. Thoracic stent grafting for acute aortic pathology. Ann Thorac Surg 2006; 82 (2) 560-565
- 47 Xu SD, Huang FJ, Yang JF , et al. Endovascular repair of acute type B aortic dissection: early and mid-term results. J Vasc Surg 2006; 43 (6) 1090-1095
- 48 Augustin N, Bauernschmitt R, Hausleiter J, Lange R. Dislocation of a stent-graft into the aortic arch during endovascular repair of a descending thoracic aortic aneurysm. Ann Thorac Surg 2006; 81 (4) 1502-1505
- 49 Holst AK, Quaade M, Andersen LI, Rohr N, Justesen P. Endovascular treatment of diseases of the descending thoracic aorta [in Danish]. Ugeskr Laeger 2006; 168 (8) 781-785
- 50 Duda SH, Pusich B, Raygrotzki S , et al. Endovascular implantation of stent-grafts in the thoracic aorta -mid-term results of a prospective controlled study [in German]. Rofo 2002; 174 (4) 485-489
- 51 Wheatley III GH, Gurbuz AT, Rodriguez-Lopez JA , et al. Midterm outcome in 158 consecutive Gore TAG thoracic endoprostheses: single center experience. Ann Thorac Surg 2006; 81 (5) 1570-1577 , discussion 1577
- 52 Wang ZG, Li C. Single-branch endograft for treating Stanford type B aortic dissections with entry tears in proximity to the left subclavian artery. J Endovasc Ther 2005; 12 (5) 588-593
- 53 Dialetto G, Covino FE, Scognamiglio G , et al. Treatment of type B aortic dissection: endoluminal repair or conventional medical therapy?. Eur J Cardiothorac Surg 2005; 27 (5) 826-830
- 54 Sugimoto I, Ohta T, Ishibashi H , et al. Simultaneous open and endoluminal repair of ruptured abdominal and thoracic aortic aneurysms: report of a case. Surg Today 2004; 34 (11) 961-964
- 55 Joung B, Ko YG, Park SH , et al. Expanding false lumen in the abdominal aorta 5 years after endovascular repair of a type B aortic dissection: successful exclusion of 3 distal re-entry sites. J Endovasc Ther 2004; 11 (5) 577-581
- 56 Bortone AS, De Cillis E, D'Agostino D, de Luca Tupputi Schinosa L. Endovascular treatment of thoracic aortic disease: four years of experience. Circulation 2004; 110 (11) (Suppl. 01) II262-II267
- 57 Iannelli G, Piscione F, Di Tommaso L, Monaco M, Chiariello M, Spampinato N. Thoracic aortic emergencies: impact of endovascular surgery. Ann Thorac Surg 2004; 77 (2) 591-596
- 58 Hansen CJ, Bui H, Donayre CE , et al. Complications of endovascular repair of high-risk and emergent descending thoracic aortic aneurysms and dissections. J Vasc Surg 2004; 40 (2) 228-234
- 59 Duebener LF, Lorenzen P, Richardt G , et al. Emergency endovascular stent-grafting for life-threatening acute type B aortic dissections. Ann Thorac Surg 2004; 78 (4) 1261-1266 , discussion 1266–1267
- 60 Grabenwoger M, Fleck T, Czerny M , et al. Endovascular stent graft placement in patients with acute thoracic aortic syndromes. Eur J Cardiothorac Surg 2003; 23 (5) 788-793 , discussion 793
- 61 Lonn L, Delle M, Falkenberg M , et al. Endovascular treatment of type B thoracic aortic dissections. J Card Surg 2003; 18 (6) 539-544
- 62 Lambrechts D, Casselman F, Schroeyers P, De Geest R, D'Haenens P, Degrieck I. Endovascular treatment of the descending thoracic aorta. Eur J Vasc Endovasc Surg 2003; 26 (4) 437-444
- 63 Bell RE, Taylor PR, Aukett M, Sabharwal T, Reidy JF. Results of urgent and emergency thoracic procedures treated by endoluminal repair. Eur J Vasc Endovasc Surg 2003; 25 (6) 527-531
- 64 Orend KH, Scharrer-Pamler R, Kapfer X, Kotsis T, Görich J, Sunder-Plassmann L. Endovascular treatment in diseases of the descending thoracic aorta: 6-year results of a single center. J Vasc Surg 2003; 37 (1) 91-99
- 65 Weber F, Schneider H, Körber T, Petzsch M, Rehders T, Nienaber CA. Percutaneous stents for the treatment of stenosis of descending aorta [in German]. Z Kardiol 2003; 92 (1) 84-89
- 66 Matravers P, Morgan R, Belli A. The use of stent grafts for the treatment of aneurysms and dissections of the thoracic aorta: a single centre experience. Eur J Vasc Endovasc Surg 2003; 26 (6) 587-595
- 67 Shim WH, Koo BK, Yoon YS , et al. Treatment of thoracic aortic dissection with stent-grafts: midterm results. J Endovasc Ther 2002; 9 (6) 817-821
- 68 Herold U, Piotrowski J, Baumgart D, Eggebrecht H, Erbel R, Jakob H. Endoluminal stent graft repair for acute and chronic type B aortic dissection and atherosclerotic aneurysm of the thoracic aorta: an interdisciplinary task. Eur J Cardiothorac Surg 2002; 22 (6) 891-897
- 69 Kato N, Shimono T, Hirano T , et al. Midterm results of stent-graft repair of acute and chronic aortic dissection with descending tear: the complication-specific approach. J Thorac Cardiovasc Surg 2002; 124 (2) 306-312
- 70 Shimono T, Kato N, Yasuda F , et al. Transluminal stent-graft placements for the treatments of acute onset and chronic aortic dissections. Circulation 2002; 106 (12) (Suppl. 01) I241-I247
- 71 Totaro M, Mazzesi G, Marullo AG, Neri E, Fanelli F, Miraldi F. Endoluminal stent grafting of the descending thoracic aorta. Ital Heart J 2002; 3 (6) 366-369
- 72 Palma JH, de Souza JA, Rodrigues Alves CM, Carvalho AC, Buffolo E. Self-expandable aortic stent-grafts for treatment of descending aortic dissections. Ann Thorac Surg 2002; 73 (4) 1138-1141 , discussion 1141–1142
- 73 Criado FJ, Clark NS, Barnatan MF. Stent graft repair in the aortic arch and descending thoracic aorta: a 4-year experience. J Vasc Surg 2002; 36 (6) 1121-1128
- 74 Bortone AS, Schena S, Mannatrizio G , et al. Endovascular stent-graft treatment for diseases of the descending thoracic aorta. Eur J Cardiothorac Surg 2001; 20 (3) 514-519
- 75 Sailer J, Peloschek P, Rand T, Grabenwöger M, Thurnher S, Lammer J. Endovascular treatment of aortic type B dissection and penetrating ulcer using commercially available stent-grafts. AJR Am J Roentgenol 2001; 177 (6) 1365-1369
- 76 Won JY, Lee DY, Shim WH , et al. Elective endovascular treatment of descending thoracic aortic aneurysms and chronic dissections with stent-grafts. J Vasc Interv Radiol 2001; 12 (5) 575-582
- 77 Yamazaki I, Imoto K, Ichikawa Y, Kondo J, Takanashi Y. Stent-graft treatment of type B aortic dissection involving the right aortic arch: case report. Jpn Circ J 2000; 64 (9) 727-728
- 78 Shimono T, Kato N, Hirano T, Takeda K, Yada I. Early and mid-term results of endovascular stent grafting for aortic aneurysms [in Japanese]. Nippon Geka Gakkai Zasshi 1999; 100 (8) 500-505
- 79 Czermak BV, Waldenberger P, Fraedrich G , et al. Treatment of Stanford type B aortic dissection with stent-grafts: preliminary results. Radiology 2000; 217 (2) 544-550
- 80 Beregi JP, Prat A, Gaxotte V, Delomez M, McFadden EP. Endovascular treatment for dissection of the descending aorta. Lancet 2000; 356 (9228) 482-483
- 81 Nienaber CA, Fattori R, Lund G , et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med 1999; 340 (20) 1539-1545
- 82 Dake MD, Kato N, Mitchell RS , et al. Endovascular stent-graft replacement for the treatment of acute aortic dissection. N Engl J Med 1999; 340 (20) 1546-1552
- 83 da Fonseca JH, Buffolo E, Carvalho AC , et al. Utilization of self-expandable prosthesis (stent) introduced through the femoral artery for treatment of dissection of the descending aorta [in Portuguese]. Arq Bras Cardiol 1998; 70 (6) 389-2