Potential risk factors of re‐intervention after endovascular repair for type B aortic dissections

Zhang, Lei; Zhou, Jian; Lu, Qingsheng; Zhao, Zhi‐Qing; Bao, Junmin; Jing, Zaiping

doi:10.1002/ccd.25733

Cited by 20 publications

(20 citation statements)

References 45 publications

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“…Among the remaining citations, 32 were excluded for the following reasons: 6 were reviews or invited commentaries, 17 were single‐case reports, 3 were TEVAR or hybrid repair only for type A aortic dissection, and 6 studies were lack of outcomes of interest (Figure ). Therefore, 50 studies were included in the meta‐analysis with a total of 8969 patients …”

Section: Resultsmentioning

confidence: 99%

Retrograde Type A Aortic Dissection After Thoracic Endovascular Aortic Repair: A Systematic Review and Meta‐Analysis

Chen

Zhang

Liu

et al. 2017

JAHA

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BackgroundRetrograde type A aortic dissection (RTAD) is a potentially lethal complication after thoracic endovascular aortic repair (TEVAR). However, data are limited regarding the development of RTAD post‐TEVAR. This systematic review aims to define the incidence, mortality, and potential risk factors of RTAD post‐TEVAR.Methods and ResultsMultiple electronic searches were performed. Fifty publications with a total of 8969 patients were analyzed. Pooled estimates for incidence and mortality of RTAD were 2.5% (95% confidence interval [CI], 2.0–3.1) and 37.1% (95% CI, 23.7–51.6), respectively. Metaregression analysis evidenced that RTAD rate was associated with hypertension (P=0.043), history of vascular surgery (P=0.042), and American Surgical Association (P=0.044). The relative risk of RTAD was 1.81 (95% CI, 1.04–3.14) for acute dissection (relative to chronic dissection) and 5.33 (95% CI, 2.70–10.51) for aortic dissection (relative to a degenerative aneurysm). Incidence of RTAD was significantly different in patients with proximal bare stent and nonbare stent endografts (relative risk [RR]=2.06; 95% CI, 1.22–3.50). RTAD occurrence rate in zone 0 was higher than other landing zones.ConclusionsThe pooled RTAD rate after TEVAR was calculated at 2.5% with a high mortality rate (37.1%). Incidence of RTAD is significantly more frequent in patients treated for dissection than those with an aneurysm (especially for acute dissection), and when the proximal bare stent was used. Rate of RTAD after TEVAR varied significantly according to the proximal Ishimaru landing zone. The more‐experienced centers tend to have lower RTAD incidences.

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Section: Resultsmentioning

confidence: 99%

Retrograde Type A Aortic Dissection After Thoracic Endovascular Aortic Repair: A Systematic Review and Meta‐Analysis

Chen

Zhang

Liu

et al. 2017

JAHA

Self Cite

178

115

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“…133 Reintervention rates for TEVAR following TBAD remain high and seem mainly associated with excessive oversizing, bare spring stent-grafting in the proximal landing zone, large aortic dilatation, and anticoagulant therapy. 86,134 Marfan disease, smoking, and type I endoleak are the main predictors. 134,135 High conversion rates to open surgical repair are reported (8%-14%), mainly due to retrograde AD.…”

Section: Rare Complicationsmentioning

confidence: 99%

Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection

et al. 2015

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Thoracic endovascular aortic repair (TEVAR) has evolved into an established treatment option for type B aortic dissection (TBAD) since it was first introduced 2 decades ago. Morbidity and mortality have decreased due to the minimally invasive character of TEVAR, with adequate stabilization of the dissection, restoration of true lumen perfusion, and subsequent positive aortic remodeling. However, several studies have reported severe setbacks of this technique. Indeed, little is known about the biomechanical behavior of implanted thoracic stent-grafts and the impact on the vascular system. This study sought to systematically review the performance and behavior of implanted thoracic stent-grafts and related biomechanical aortic changes in TBAD patients in order to update current knowledge and future perspectives.

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“…16 Sze et al followed up patient who underwent TEVAR for aortic dissection and found that 59% of them had endoleak, and they found coverage of the left subclavian artery, small radius of aortic arch curvature and greatest length of unapposed proximal stent-graft were associated with endoleak. 17 And as we previous reported 18 and as Mestres et al reviewed, 19 re-interventions after TEVAR are mostly related to endoleaks. In our experience, it should be deal with aggressively if type I endoleak visualized early and fast after aorta visualized in aortography after stent-grafts deployment.…”

Section: Discussionmentioning

confidence: 73%

Unplanned stents in thoracic endovascular aortic repair for type B aortic dissection: A 16-year single-center report

et al. 2017

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Background Unplanned stents in thoracic endovascular aortic repair mean additional stents implantation beyond the preoperative planning to achieve operation success. This study aimed to reveal the prevalence and consequences of unplanned stents in thoracic endovascular aortic repair for type B aortic dissection and explore the reasons, risk factors and solutions for unplanned stents. Methods Retrospectively analysis consecutive patients diagnosed as type B aortic dissection with initial tear originating distal from the left subclavian artery and underwent thoracic endovascular aortic repair from September 1998 to June 2014 in our center. Results Under the criteria, this study enrolled 322 patients, with 83 (25.8%) patients in unplanned group. The incidence rate of unplanned stents in thoracic endovascular aortic repair for type B aortic dissection in each year demonstrates as a bimodal curve. The curve showed that, 2003 and, 2004 was the first and highest peak and 2007 was the second peak. There was no difference in five-year survival rate between planned and unplanned patients (log-rank test, p = 0.994). The unplanned group had higher hospitalization expenses (142,699.08 ± 78,446.75 yuan vs. 175,238.58 ± 34,838.01 yuan; p = 0.019), longer operation time (104.50 ± 93.24 min vs. 179.08 ± 142.47 min; p < 0.001) and hospitalization time (17.07 ± 16.62 d vs. 24.00 ± 15.34 d; p = 0.001). The reasons for unplanned stents were type Ia endoleak (46 patients, 55.4%), bird beak (25 patients, 30.1%), and inappropriate shaping of stent (9 patients, 10.8%). Asymptomatic aortic dissection patients had higher incidence of unplanned stents. Short proximal neck length (2.66 ± 0.59 mm vs. 2.50 ± 0.51 mm; p = 0.016), short stent coverage length (154.62 ± 41.12 mm vs. 133.60 ± 44.33 mm; p = 0.002), and large distal stent oversize (75.44±10.77% vs. 82.68±15.80%; p <0.001) were risk factors for unplanned stents in thoracic endovascular aortic repair. Conclusion There are some special risk factors and reasons for unplanned stents in thoracic endovascular aortic repair for type B aortic dissection. Knowing these can we reduce the utilization of unplanned stents with appropriate methods.

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Potential risk factors of re‐intervention after endovascular repair for type B aortic dissections

Abstract: we concluded that chronic phase, smoking and too big oversizing were potential risk factors of re-intervention.

Cited by 20 publications

References 45 publications

Retrograde Type A Aortic Dissection After Thoracic Endovascular Aortic Repair: A Systematic Review and Meta‐Analysis

Retrograde Type A Aortic Dissection After Thoracic Endovascular Aortic Repair: A Systematic Review and Meta‐Analysis

Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection

Unplanned stents in thoracic endovascular aortic repair for type B aortic dissection: A 16-year single-center report

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