Patients who have survived an acute aortic dissection remain at risk for postdissection thoracoabdominal aortic aneurysms (PD-TAAAs). Fenestrated/branched endovascular repair for PD-TAAA is increasingly used in some high-volume centers, but outcomes are still limited because of the additional challenges compared to atherosclerotic thoracoabdominal aneurysms. This study was performed to evaluate the literature on fenestrated/branched endovascular repair for PD-TAAAs.
Methods:
PubMed, Embase, and the Cochrane Database were searched for relevant studies published until September 2019. Outcome data were extracted to evaluate the technical success, 30-day mortality, later survival, major complications, endoleaks, target vessel patency, and reintervention. Studies were analyzed in a pooled proportion meta-analysis.
Results:
In total, 143 patients from 4 studies were identified for the pooled data analysis. The pooled technical success rate was 98% (95% CI: 86%-100%). After the treatment, the overall estimated 30-day mortality rate was 3% (95% CI: 1%-8%), early spinal cord ischemia rate was 10% (95% CI: 4%-21%), early renal injury rate was 5% (95% CI: 1%-19%), endoleak rate was 33% (95% CI: 22%-47%), reintervention rate at a median follow-up of 22.5 months was 34% (95% CI: 27%-42%), and all-cause mortality rate was 12% (95% CI: 6%-24%).
Conclusions:
The use of fenestrated/branched stent grafts for the treatment of PD-TAAA appears generally feasible based on the limited literature, but endoleaks and reinterventions are frequent.
WerlinECKaushikSGasperWJ, et al.Multibranched endovascular aortic aneurysm repair in patients with and without chronic aortic dissections. J Vasc Surg. 2019;70(5):1419–1426.
2.
EvangelistaASalasARiberaA., et al.Long-term outcome of aortic dissection with patent false lumen: predictive role of entry tear size and location. Circulation. 2012;125(25):3133–3141.
3.
MuranaGCastrovinciSKloppenburgG, et al.Open thoracoabdominal aortic aneurysm repair in the modern era: results from a 20-year single-centre experience. Eur J Cardiothorac Surg. 2016;49(5):1374–1381.
4.
BashirMShawMFokM, et al.Long-term outcomes in thoracoabdominal aortic aneurysm repair for chronic type B dissection. Ann Cardiothorac Surg. 2014;3(4):385–392.
5.
LeMaireSAPriceMDGreenSYSamanthaZJosephSC. Results of open thoracoabdominal aortic aneurysm repair. Ann Cardiothorac Surg. 2012;1(3):286–292.
6.
StroupDFBerlinJAMortonSC, et al.Meta-analysis of observational studies in epidemiology: a proposal for reporting. meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–2012.
7.
KitagawaAGreenbergRKEagletonMJMastracciTMRoselliEE. Fenestrated and branched endovascular aortic repair for chronic type B aortic dissection with thoracoabdominal aneurysms. J Vasc Surg. 2013;58(3):625–634.
8.
LawYTsilimparisNRohlffsF, et al.Fenestrated or branched endovascular aortic repair for postdissection thoracoabdominal aortic aneurysm. J Vasc Surg. 2019;70(2):404–412.
9.
OikonomouKKasprzakPKatsargyrisAMarquesDMPPfisterKVerhoevenELG. Mid-term results of fenestrated/branched stent grafting to treat post-dissection thoraco-abdominal aneurysms. Eur J Vasc Endovasc Surg. 2018;57(1):102–109.
10.
SpearRHertaultAVan CalsterK, et al.Complex endovascular repair of postdissection arch and thoracoabdominal aneurysms. J Vasc Surg. 2017;67(3):685–693.
11.
RiambauVBocklerDBrunkwallJ, et al.Editor’s choice—management of descending thoracic aorta diseases: clinical practice guidelines of the European society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg. 2017;53(1):4–52.
12.
MaruiAMochizukiTMitsuiNKoyamaTKimuraFHoribeM. Toward the best treatment for uncomplicated patients with type B acute aortic dissection: A consideration for sound surgical indication. Circulation. 1999;100(19 Suppl):II275–280.
13.
EstreraALSandhuHAfifiRO, et al.Open repair of chronic complicated type B aortic dissection using the open distal technique. Ann Cardiothorac Surg. 2014;3(4):375–384.
14.
MoulakakisKGKaraolanisGAntonopoulosCN, et al.Open repair of thoracoabdominal aortic aneurysms in experienced centers. J Vasc Surg. 2018;68(2):634–645e12.
RohlffsFTsilimparisNDienerH, et al.Chronic type B aortic dissection: indications and strategies for treatment. J Cardiovasc Surg (Torino). 2015;56(2):231–238.
17.
ThrumurthySGKarthikesalingamAPattersonBO, et al.A systematic review of mid-term outcomes of thoracic endovascular repair (TEVAR) of chronic type B aortic dissection. Eur J Vasc Endovasc Surg. 2011;42(5):632–647.
18.
Marques deMPOikonomouKVerhoevenELKatsargyrisA. Techniques and outcomes of secondary endovascular repair for postdissection TAA/TAAA. J Cardiovasc Surg (Torino). 2018;59(6):767–774.
19.
NienaberCAKischeSZellerT, et al.Provisional extension to induce complete attachment after stent-graft placement in type B aortic dissection: the PETTICOAT concept. J Endovasc Ther. 2006;13(6):738–746.
20.
KazimierczakARynioPJedrzejczakT, et al.Expanded petticoat technique to promote the reduction of contrasted false lumen volume in patients with chronic type B aortic dissection. J Vasc Surg. 2019;70(6):1782–1791.
21.
ChuterTAGordonRLReillyLMGoodmanJDMessinaLM. An endovascular system for thoracoabdominal aortic aneurysm repair. J Endovasc Ther, 2001;8(1):25–33.
22.
WalkerJKaushikSHoffmanM, et al.Long-term durability of multibranched endovascular repair of thoracoabdominal and pararenal aortic aneurysms. J Vasc Surg. 2019;69(2):341–347.
23.
EagletonMJFollansbeeMWolskiKMastracciTKuramochiY. Fenestrated and branched endovascular aneurysm repair outcomes for type II and III thoracoabdominal aortic aneurysms. J Vasc Surg. 2016;63(4):930–942.
24.
FernandezCCSobelJDGasperWJ, et al.Standard off-the-shelf versus custom-made multibranched thoracoabdominal aortic stent grafts. J Vasc Surg. 2016;
63(5):1208–1215.
25.
SweetMPStarnesBWTatumB. Endovascular treatment of thoracoabdominal aortic aneurysm using physician-modified endografts. J Vasc Surg, 2015;62(5):1160–1167.
26.
VerhoevenELParaskevasKIOikonomouK, et al.Fenestrated and branched stent-grafts to treat post-dissection chronic aortic aneurysms after initial treatment in the acute setting. J Endovasc Ther. 2012;19(3):343–349.
27.
LiuJLiZFengJ, et al.Total endovascular repair with parallel stent-grafts for postdissection thoracoabdominal aneurysm after prior proximal repair. J Endovasc Ther. 2019;26(5):668–675.
28.
HsuMYSuTWSuIH, et al.Use of the octopus technique for endovascular treatment of complex aortic lesions. J Vasc Interv Radiol. 2019;30(4):495–502.
29.
KouchoukosNTKulikACastnerCF. Open thoracoabdominal aortic repair for chronic type B dissection. J Thorac Cardiovasc Surg. 2015;149(2 Suppl):S125–S129.
30.
JainAFlohrTFJohnstonWF, et al.Staged hybrid repair of extensive thoracoabdominal aortic aneurysms secondary to chronic aortic dissection. J Vasc Surg. 2016;63(1):62–69.
31.
JohnstonWFUpchurchGRJrTracciMC, et al.Staged hybrid approach using proximal thoracic endovascular aneurysm repair and distal open repair for the treatment of extensive thoracoabdominal aortic aneurysms. J Vasc Surg, 2012;56(6):1495–1502.
32.
ConstantinouJKelayAMastracciTM. Open surgery for chronic dissection. J Vasc Surg. 2016;63(5):1377–1383.
33.
CorveraJCopelandHBlitzerD, et al.Open repair of chronic thoracic and thoracoabdominal aortic dissection using deep hypothermia and circulatory arrest. J Thorac Cardiovasc Surg. 2017;154(2):389–395.
34.
SpanosKKolbelTKubitzJC, et al.Risk of spinal cord ischemia after fenestrated or branched endovascular repair of complex aortic aneurysms. J Vasc Surg. 2019;69(2):357–366.
35.
EtzCDWeigangEHartertM, et al.Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair: a position paper of the vascular domain of the European association for cardio-thoracic surgery dagger. Eur J Cardiothorac Surg. 2015;47(6):943–957.
36.
OderichGSRibeiroMReis deSL, et al.Endovascular repair of thoracoabdominal aortic aneurysms using fenestrated and branched endografts. J Thorac Cardiovasc Surg. 2017;153(2):S32–S41e7.
37.
SchneiderDBAgrusaCJEllozySH, et al.Analysis of the learning curve and patient outcomes of endovascular repair of thoracoabdominal aortic aneurysms using fenestrated and branched stent grafts: prospective, nonrandomized, single-center physician-sponsored investigational device exemption clinical study. Ann Surg. 2018;268(4):640–649.
38.
BoufiMPattersonBOLoundouAD, et al.Endovascular versus open repair for chronic type b dissection treatment: a meta-analysis. Ann Thorac Surg. 2019;107(5):1559–1570.
39.
MastracciTMCarrellTConstantinouJ, et al.Editor’s choice—effect of branch stent choice on branch-related outcomes in complex aortic repair. Eur J Vasc Endovasc Surg. 2016;51(4):536–542.
40.
MastracciTMGreenbergRKEagletonMJHernandezAV. Durability of branches in branched and fenestrated endografts. J Vasc Surg. 2013;57(4):926–933. discussion 933.
