Fenestrated and branched stent grafts for the treatment of post-dissection thoracoabdominal aortic aneurysms

Transcatheter electrosurgical septotomy technique for chronic postdissection aortic aneurysms

“…In these patients, fenestrated-branched endovascular repair (FB-EVAR) has been increasingly used, with low mortality and morbidity. 6 , 7 , 8 , 9 Excessive compression of the true lumen or vessel originating from the false lumen represents a technical challenge due to limited space for stent graft expansion and catheter manipulations and the frequent need for reentrance techniques to successfully incorporate the target vessel. Transcatheter electrosurgical septotomy was originally used to divide aortic valve leaflets before transcatheter aortic valve replacement to prevent coronary artery obstruction 10 but later was applied as an adjunctive technique in patients with chronic postdissection aneurysms.…”

A Systematic Review and an Updated Meta-Analysis of Fenestrated/Branched Endovascular Aortic Repair of Chronic Post-Dissection Thoracoabdominal Aortic Aneurysms

“…Of these, 203 were excluded for one or more of the following reasons: provided data on aortic arch disease (n = 21); reported on open or hybrid repair (n = 17); provided data on Mesh Stent (n = 1); case reports, technical notes or case series with >10 patients (n = 18); editorial and review articles (n = 6); provided mixed data on TAAs and TAAAs (n = 14); provided mixed data on degenerative TAAAs and PDTAAAs (n = 51); were irrelevant (n = 61); and/or reported on overlapping patient populations (n = 14) (Figure 1). Finally, 10 studies [32][33][34][35][36][37][38][39][40][41], with a total of 585 patients (1255.65 p-ys), were deemed eligible for inclusion in the meta-analysis (Table 1) (Figure 1). CMD: custom-made device; PMSG: physician-modified stent graft.…”

“…The mean maximum aneurysm diameter was 60.2 mm (95% CI 56.4 to 63.9). Only five studies [34][35][36]38,40] provided data regarding the nature of dissection for a total of 223 patients; 65 of them (29.1%) had a residual type A AD, and 158 (70.9%) had a chronic type B AD. The vast majority of the patients (78.4%) were operated on in an elective setting, whereas 23.1% and 2.9% of the patients were operated on in an urgent or emergency setting, respectively.…”

“…Durability: The pooled estimate for 12-month overall survival was 90% (95% CI 85% to 93.5%, I 2 = 5.2%) (Supplementary Figure S9). Among seven studies [32,35,36,[38][39][40][41] providing data, the pooled estimates for 24-month and 36-month survival were 87.8% (95% CI 80.9% to 92.5%, I 2 = 54%) and 85.5% (95% CI 76.5% to 91.5%, I 2 = 68%), respectively (Supplementary Figures S10 and S11).…”

“…TV patency data were provided in eight studies [33][34][35][36][37][38][39][40] for 12 months with a pooled estimate of 97.6% (95% CI 94.9% to 98.8%, I 2 = 0%) (Supplementary Figure S12) and in five studies [35,36,[38][39][40] for 24 months with a pooled rate of 96.7% (95% CI 93.5% to 98.3%, I 2 = 0%) (Supplementary Figure S13). The 36-month TV patency was estimated at 94.3% (95% CI 91.8% to 96.1%, I 2 = 0%) (Supplementary Figure S14) among six eligible studies [32,35,36,[38][39][40].…”