Aortic Dissection Following Endovascular Aneurysm Repair - A Systematic Review and Management Algorithm

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Aortic Disease

Background:

• Aortic dissection following endovascular aneurysm repair (EVAR) can be iatrogenic or de novo.
• Complications include endograft compression, endoleak, and rupture, impacting patient outcomes.
• Management strategies vary based on dissection type and timing.

Purpose of the Study:

• To systematically review dissections after EVAR and fenestrated/branched EVAR (F/BrEVAR).
• To identify complications specific to iatrogenic and de novo dissections.
• To develop a management algorithm based on clinical presentation.

Main Methods:

• Comprehensive literature search of MEDLINE, Embase, and CENTRAL databases.
• Data collection on timing, tear location, endograft involvement, complications, management, and outcomes.
• Descriptive data analysis and outcome comparison based on dissection type and timing.

Main Results:

• 46 patients from 37 studies were analyzed.
• Endograft compression (52.2%), endoleak (15.2%), and rupture (13.0%) were common complications.
• Type A dissection had high mortality (20.0%); early Type B dissection (diagnosed <4 weeks) had no mortality with medical management, while late Type B dissection (>4 weeks) had 25.8% mortality.

Conclusions:

• Aortic dissection post-EVAR presents significant risks, including endograft compression, endoleak, and rupture.
• Type A and late Type B dissections are associated with higher complication rates and mortality.
• Early Type B dissection may be effectively managed non-surgically.