Purpose: Up to 10% of acute type A aortic dissection (TAAD) patients are deemed unfit for open surgical repair, exposing these patients to high mortality rates. In recent years, thoracic endovascular aortic repair has proven to be a promising alternative treatment modality in specific cases. This study presents a comprehensive overview of the current state of catheter-based interventions in the setting of primary TAAD.
Methods: A literature search was conducted, using MEDLINE and PubMed databases according to PRISMA guidelines, updated until January 2020. Articles were selected if they reported on the endovascular repair of DeBakey Type I and II aortic dissections. The exclusion criteria were retrograde type A dissection, hybrid procedures, and combined outcome reporting of mixed aortic pathologies (e.g., pseudoaneurysm and intramural hematoma).
Results: A total of 31 articles, out of which 19 were case reports and 12 case series, describing a total of 92 patients, were included. The median follow-up was 6 months for case reports and the average follow-up was 14 months for case series. Overall technical success was 95.6% and 30-day mortality of 9%. Stroke and early endoleak rates were 6% and 18%, respectively. Reintervention was required in 14 patients (15%).
Conclusion: This review not only demonstrates that endovascular repair in the setting of isolated TAAD is feasible with acceptable outcomes at short-term follow-up, but also underlines a lack of mid-late outcomes and reporting consistency. Studies with longer follow-up and careful consideration of patient selection are required before endovascular interventions can be widely introduced.
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http://dx.doi.org/10.1111/jocs.15192 | DOI Listing |
Ann Thorac Surg
January 2025
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA; Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Philadelphia, PA.
Background: This study describes in detail the clinical burden of malperfusion associated with acute Type A aortic dissection (ATAAD) in a large, national cohort and the effect of treatment strategy on outcomes.
Methods: All patients undergoing repair of ATAAD between 2017 and 2020 in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were studied. Malperfusion was defined using STS definitions based on imaging or surgeon's evaluation.
Eur J Vasc Endovasc Surg
January 2025
Department of Vascular and Endovascular Surgery, General Hospital and Paracelsus Medical University, Nuremberg, Germany.
J Vasc Surg
January 2025
Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address:
Objective: As aneurysmal disease is progressive, proximal disease progression and para-anastomotic aneurysms are complications experienced after open infrarenal abdominal aortic aneurysm repair (AAA). As such, fenestrated or branched endovascular repair (F/BEVAR) may be indicated in these patients. Data describing fenestrated endovascular aneurysm repair after prior open repair are limited to institutional databases.
View Article and Find Full Text PDFAnn Vasc Surg
January 2025
Department of Surgery, Division of Cardiothoracic Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
Objective: Medicare insures over 65 million Americans and is a primary driver of private insurance reimbursement rates. However, public data shows Medicare reimbursement for comparatively complex procedures such as aortic aneurysm repair is disproportionate. Medicare reimbursement rates are multifactorial and highly localized, yet little is known about nationwide trends.
View Article and Find Full Text PDFJACC Cardiovasc Interv
January 2025
Sanger Heart & Vascular Institute, Charlotte, North Carolina, USA.
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