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Systematic Review of Reintervention After Thoracic Endovascular Repair for Chronic Type B Dissection
Mourad Boufi1, Benjamin O Patterson2, Matthew Joe Grima2
1St. George's Vascular Institute, St. George's Hospital National Health Service Trust, London, United Kingdom; Department of Vascular Surgery, Assistance Publique-Hôpitaux de Marseille (APHM), University Hospital Nord, Marseille, France; Aix-Marseille Université, Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Unité Mixte de Recherche T24, Marseille, France.
Endovascular repair of chronic aortic dissections requires reintervention in 6/100 patient-years, often due to stent issues. Distal false lumen perfusion is a common complication, with no single risk factor identified.
Area of Science:
- Vascular Surgery
- Endovascular Interventions
- Aortic Disease Management
Background:
- Chronic aortic dissections pose significant risks, necessitating effective treatment strategies.
- Endovascular repair is a common approach, but long-term outcomes require scrutiny.
- Reintervention rates after endovascular repair are a critical metric for assessing treatment durability.
Purpose of the Study:
- To systematically review the incidence, mechanisms, and risk factors associated with aortic-related reintervention following endovascular repair of chronic aortic dissections.
- To identify common complications and their frequencies after endovascular aortic dissection repair.
- To determine if specific patient or treatment factors predict the need for reintervention.
Main Methods:
- A systematic review of 28 studies involving 1,249 patients with chronic aortic dissections treated with endovascular repair.
- Analysis of patient data with a median follow-up of 27 months.
- Quantification of reintervention rates, rupture events, and surgical conversions per 100 patient-years.
Main Results:
- The overall reintervention rate was 6 per 100 patient-years, with stent-related issues accounting for 80.2% of reinterventions.
- Distal false lumen perfusion was the most frequent complication, observed in 40.5% of cases.
- No single risk factor, including treatment timing, disease extent, graft coverage, or aortic remodeling, was significantly associated with reintervention.
Conclusions:
- Endovascular repair of chronic aortic dissections has a notable reintervention rate, primarily driven by stent-related complications.
- Distal false lumen perfusion is a prevalent issue requiring attention in post-procedural management.
- Current data do not identify specific risk factors, highlighting the need for standardized reporting and further research to optimize long-term outcomes.
