Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms

Upchurch, Gilbert R.; Escobar, Guillermo A.; Azizzadeh, Ali; Beck, Adam W.; Conrad, Mark F.; Matsumura, Jon S.; Murad, Mohammad Hassan; Perry, Richard; Singh, Michael J.; Veeraswamy, Ravi K.; Wang, Grace J.

doi:10.1016/j.jvs.2020.05.076

Cited by 223 publications

(146 citation statements)

References 202 publications

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“…The final analysis included 5 articles published between 2010 and 2020 by the American College of Cardiology Foundation/American Heart Association (ACCF/AHA), 1 the Japanese Circulation Society (JCS), 2 the European Society of Cardiology (ESC), 3 the European Society of Vascular Surgery (ESVS), 4 and the Society for Vascular Surgery (SVS). 5…”

Section: Systematic Reviewmentioning

confidence: 99%

“…MRA and transesophageal echocardiography may be used to provide further information. 11,12 CTA has established its role in everyday clinical practice, and the level of evidence in the latest SVS guidelines 5 has increased compared to the ESVS guidelines 4 (level of evidence B vs C, respectively). Furthermore, in the SVS guidelines, 5 a fine cut CTA (≤0.25 mm) from the arch branches down to the femoral arteries (level of evidence A) and a 3D centerline reconstruction software (level of evidence B) are recommended for TEVAR planning.…”

Section: Selected Controversial Topicsmentioning

confidence: 99%

“…For decades, cardiovascular societies have developed and published guidelines 1–5 regarding the management of thoracic aortic diseases to summarize and evaluate all available evidence and expert opinions on different aspects of thoracic aortic pathologies, including some groundbreaking improvements that have arisen during the past 10 years. For example, preoperative patient selection, endovascular devices and techniques, and regionalization of referrals to high-volume tertiary care centers, have improved clinical outcomes and widely replaced conventional open repair.…”

Section: Introductionmentioning

confidence: 99%

“…For example, preoperative patient selection, endovascular devices and techniques, and regionalization of referrals to high-volume tertiary care centers, have improved clinical outcomes and widely replaced conventional open repair. 4–7 Guidelines aim to standardize the management of thoracic aortic diseases, improve patient care, and ensure the delivery of consistent outcomes, especially when considering the involvement of different specialties in thoracic aortic disease treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Thoracic endovascular aortic repair (TEVAR) is an alternative treatment modality that has been rapidly embraced by clinicians. 5–7 Fundamentally, TEVAR is a far less invasive approach than open repair, and its availability and relative ease of application have changed and extended management options, encompassing patients deemed unfit for open repair. 5,8,9 The broad expansion of TEVAR requires systematic consideration of indications, appropriateness, limitations, and application of this treatment.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Management of Descending Thoracic Aortic Diseases: Similarities and Differences Among Cardiovascular Guidelines

Σπανός

Nana

Behrendt³

et al. 2021

J Endovasc Ther

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Cardiovascular societies have developed recommendations regarding the management of thoracic aortic diseases. While improvements in treatment have been observed during the past decade in regard to patient selection, thoracic endovascular aortic repair (TEVAR) and associated techniques, and high-volume centralization, the broad expansion of TEVAR has raised considerations about its indications, appropriateness, limitations, and application. The aim of this systematic review was to assess the similarities and differences among current cardiovascular societies’ guidelines for the management of thoracic aortic diseases. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from January 2009 to May 2020. The initial search identified 990 articles. After exclusion of duplicate or inappropriate articles, the final analysis included 5 articles from cardiovascular societies published between 2010 and 2020. Selected controversial topics were analyzed, including diagnosis, imaging, spinal cord ischemia prevention, and management of the most important thoracic aortic pathologies. The analysis included data concerning the therapeutic approach in acute and chronic type B aortic dissection, penetrating aortic ulcer, intramural hematoma, thoracic aortic aneurysm, and traumatic aortic injury, as well a discussion of inflammatory aneurysms, aortitis, and genetic syndromes. The review presents consistent and controversial recommendations, as well as “gray zone” issues that need further investigation. There was significant overlap and agreement among the 5 societies regarding the management of thoracic aortic diseases. Especially in dissection and aneurysm management, TEVAR has established its role as the treatment of choice. However, robust evidence is still needed in many aspects of the management of thoracic aortic pathologies.

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Section: Systematic Reviewmentioning

confidence: 99%

Section: Selected Controversial Topicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Management of Descending Thoracic Aortic Diseases: Similarities and Differences Among Cardiovascular Guidelines

Σπανός

Nana

Behrendt³

et al. 2021

J Endovasc Ther

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Outcomes After Endovascular Aortic Intervention in Patients With Connective Tissue Disease

et al. 2023

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ImportanceEndovascular treatment is not recommended for aortic pathologies in patients with connective tissue diseases (CTDs) other than in redo operations and as bridging procedures in emergencies. However, recent developments in endovascular technology may challenge this dogma.ObjectiveTo assess the midterm outcomes of endovascular aortic repair in patients with CTD.Design, Setting, and ParticipantsFor this descriptive retrospective study, data on demographics, interventions, and short-term and midterm outcomes were collected from 18 aortic centers in Europe, Asia, North America, and New Zealand. Patients with CTD who had undergone endovascular aortic repair from 2005 to 2020 were included. Data were analyzed from December 2021 to November 2022.ExposureAll principal endovascular aortic repairs, including redo surgery and complex repairs of the aortic arch and visceral aorta.Main Outcomes and MeasuresShort-term and midterm survival, rates of secondary procedures, and conversion to open repair.ResultsIn total, 171 patients were included: 142 with Marfan syndrome, 17 with Loeys-Dietz syndrome, and 12 with vascular Ehlers-Danlos syndrome (vEDS). Median (IQR) age was 49.9 years (37.9-59.0), and 107 patients (62.6%) were male. One hundred fifty-two (88.9%) were treated for aortic dissections and 19 (11.1%) for degenerative aneurysms. One hundred thirty-six patients (79.5%) had undergone open aortic surgery before the index endovascular repair. In 74 patients (43.3%), arch and/or visceral branches were included in the repair. Primary technical success was achieved in 168 patients (98.2%), and 30-day mortality was 2.9% (5 patients). Survival at 1 and 5 years was 96.2% and 80.6% for Marfan syndrome, 93.8% and 85.2% for Loeys-Dietz syndrome, and 75.0% and 43.8% for vEDS, respectively. After a median (IQR) follow-up of 4.7 years (1.9-9.2), 91 patients (53.2%) had undergone secondary procedures, of which 14 (8.2%) were open conversions.Conclusions and RelevanceThis study found that endovascular aortic interventions, including redo procedures and complex repairs of the aortic arch and visceral aorta, in patients with CTD had a high rate of early technical success, low perioperative mortality, and a midterm survival rate comparable with reports of open aortic surgery in patients with CTD. The rate of secondary procedures was high, but few patients required conversion to open repair. Improvements in devices and techniques, as well as ongoing follow-up, may result in endovascular treatment for patients with CTD being included in guideline recommendations.

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Endovascular Repair of Thoracic Aortic Aneurysms

Denesopolis

Yau

Rivera

2023

Endovascular Interventions

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Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms

Cited by 223 publications

References 202 publications

Management of Descending Thoracic Aortic Diseases: Similarities and Differences Among Cardiovascular Guidelines

Management of Descending Thoracic Aortic Diseases: Similarities and Differences Among Cardiovascular Guidelines

Outcomes After Endovascular Aortic Intervention in Patients With Connective Tissue Disease

Endovascular Repair of Thoracic Aortic Aneurysms

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