Reintervention after thoracic endovascular aortic repair deserves more attention

Abstract

study and held an optimistic attitude towards long-term outcomes of thoracic endovascular aortic repair (TEVAR) for aortic dissection compared with open surgery and medical treatment (2).Dr. Hsu and Dr. Shih suggested the limitation of the study with large heterogeneity. Although subgroup analysis and sensitivity analysis were conducted, the heterogeneity was still high. This situation might be improved by strictly setting the inclusion and exclusion criteria and evaluating the quality of current available studies. However, current high quality study was scarce, because there were a few studies focused on the reintervention of TEVAR. Nevertheless, the present meta-analysis was performed by merging enough data to draw meaningful conclusions and improve the prognosis of the complex clinical problem. And this study provided an overview of reintervention of TEVAR, including the incidence and most common reasons. The most common reasons of reintervention were type I endoleak (35.2%), new dissection (14.4%), and persistent false-lumen perfusion (9.3%).Dr. Hsu and Dr. Shih also pointed out that morphology data were not taken into consideration when the risk factors of reintervention were identified by regression analyses. The perioperative morphologic characteristics of aorta would affect the surgeons' decision about the choice of treatment method. However, it should be noted that the absence of original morphology data in most studies made the analysis of the potential effect of morphology on outcomes after TEVAR impossible. From the current available studies, branch vessel involvement, a patent entry tear after TEVAR (3) and native thoracic aortic curvature (4) might be predictors of complications after TEVAR during long-term follow-up period.TEVAR was introduced as a minimally invasive procedure for aortic dissection compared with open surgery, as reported in several registration studies. Although TEVAR had the advantages of lower perioperative morbidity and mortality for type B aortic dissection, the advantages seemed to depend on a high rate of reintervention. Previous study reported that more than 20% of patients needed reintervention at 1-year after TEVAR (5) and the number reached up to 54% at 6-year (6).In most situations, the aim of reintervention was to achieve favorable aortic remodeling, prompt false lumen thrombosis and decrease perioperative mortality (7). However, several reports demonstrated relatively high mortality ranging from 11.1% to 66.6% after reintervention (8,9). The mechanism of negative vascular remodeling after reintervention needed to be elucidated in the future study.