File Download

There are no files associated with this item.

  Links for fulltext
     (May Require Subscription)
Supplementary

Article: Safety and Efficacy of Inner Branched Stent-Graft in the Treatment of Aortic Arch Disease: A Systematic Review

TitleSafety and Efficacy of Inner Branched Stent-Graft in the Treatment of Aortic Arch Disease: A Systematic Review
Authors
Keywordsaortic arch aneurysm
aortic arch dissection
branched stent-graft
endoleak
endovascular repair
Issue Date2023
Citation
Journal of Endovascular Therapy, 2023 How to Cite?
AbstractObjective: To provide a descriptive overview on the contemporary outcomes of thoracic endovascular arch repair with inner branched endoprosthesis (bTEVAR) for the treatment of aortic arch pathologies. Methods: A comprehensive literature search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Pre-defined search terms were used to interrogate PubMed and OVID Medline databases from January 1999 to July 2022. Patient characteristics, indication for treatment, procedural data, mortality rates, postoperative complications, and reintervention rate during follow-up were evaluated. Results: Nineteen articles were included, encompassing a total of 618 patients who received bTEVAR, most of which were double-branched (63.9%, n=395). The main indication for treatment was aneurysm secondary to chronic aortic dissection (38.8%, n=240/618) with a mean maximum diameter of 58.3±11.4 mm. Pooled mean technical success rate was 97.4±4.4% (95% confidence interval [CI]=95.1%–99.5%); 2 and 3 patients required conversion to chimney technique and open repair, respectively. Among the pooled rates of early complications, postoperative stroke was the highest (10.5%; 95% CI=6.8%–14.3%). Thirty-day and in-hospital mortality rate was 5.5% (95% CI=2.6%–9.7%). Forty patients (6.5%; 95% CI=2.5%–9.5%) required early reintervention. During a mean follow-up of 20.7±13.5 months, the mortality rate was 18.2% (n=108/593; 95% CI=8.6%–20.6%) where 12 (11.1%) were aortic-related. Pooled late reintervention rate was 9.6% (95% CI=4.8%–14.3%). Comparison of demographics and outcomes found no significant difference between single and double bTEVAR. Conclusion: Branched thoracic endovascular aortic repair is a promising approach for aortic arch pathologies with a high technical success rate despite a steep learning curve. However, contemporary outcomes reflect that postoperative stroke remains the predominant concern. Further experience and long-term follow-up are required to sufficiently elucidate the safety and durability of bTEVAR in the management of aortic pathologies for high-risk patients. Clinical Impact: This systematic review summarized the contemporary outcomes of thoracic endovascular aortic repair with different inner branched stent-grafts for the management of aortic arch pathologies. Pooled results from nineteen studies with 618 patients demonstrated a high technical success rate and an acceptable mortality rate. However, postoperative stroke remains the major concern. Long-term follow-up is needed to evaluate its durability.
Persistent Identifierhttp://hdl.handle.net/10722/345348
ISSN
2023 Impact Factor: 1.7
2023 SCImago Journal Rankings: 1.006

 

DC FieldValueLanguage
dc.contributor.authorKwan, Kristine J.S.-
dc.contributor.authorLi, Hai Lei-
dc.contributor.authorChan, Yiu Che-
dc.contributor.authorCheng, Stephen W.K.-
dc.date.accessioned2024-08-15T09:26:47Z-
dc.date.available2024-08-15T09:26:47Z-
dc.date.issued2023-
dc.identifier.citationJournal of Endovascular Therapy, 2023-
dc.identifier.issn1526-6028-
dc.identifier.urihttp://hdl.handle.net/10722/345348-
dc.description.abstractObjective: To provide a descriptive overview on the contemporary outcomes of thoracic endovascular arch repair with inner branched endoprosthesis (bTEVAR) for the treatment of aortic arch pathologies. Methods: A comprehensive literature search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Pre-defined search terms were used to interrogate PubMed and OVID Medline databases from January 1999 to July 2022. Patient characteristics, indication for treatment, procedural data, mortality rates, postoperative complications, and reintervention rate during follow-up were evaluated. Results: Nineteen articles were included, encompassing a total of 618 patients who received bTEVAR, most of which were double-branched (63.9%, n=395). The main indication for treatment was aneurysm secondary to chronic aortic dissection (38.8%, n=240/618) with a mean maximum diameter of 58.3±11.4 mm. Pooled mean technical success rate was 97.4±4.4% (95% confidence interval [CI]=95.1%–99.5%); 2 and 3 patients required conversion to chimney technique and open repair, respectively. Among the pooled rates of early complications, postoperative stroke was the highest (10.5%; 95% CI=6.8%–14.3%). Thirty-day and in-hospital mortality rate was 5.5% (95% CI=2.6%–9.7%). Forty patients (6.5%; 95% CI=2.5%–9.5%) required early reintervention. During a mean follow-up of 20.7±13.5 months, the mortality rate was 18.2% (n=108/593; 95% CI=8.6%–20.6%) where 12 (11.1%) were aortic-related. Pooled late reintervention rate was 9.6% (95% CI=4.8%–14.3%). Comparison of demographics and outcomes found no significant difference between single and double bTEVAR. Conclusion: Branched thoracic endovascular aortic repair is a promising approach for aortic arch pathologies with a high technical success rate despite a steep learning curve. However, contemporary outcomes reflect that postoperative stroke remains the predominant concern. Further experience and long-term follow-up are required to sufficiently elucidate the safety and durability of bTEVAR in the management of aortic pathologies for high-risk patients. Clinical Impact: This systematic review summarized the contemporary outcomes of thoracic endovascular aortic repair with different inner branched stent-grafts for the management of aortic arch pathologies. Pooled results from nineteen studies with 618 patients demonstrated a high technical success rate and an acceptable mortality rate. However, postoperative stroke remains the major concern. Long-term follow-up is needed to evaluate its durability.-
dc.languageeng-
dc.relation.ispartofJournal of Endovascular Therapy-
dc.subjectaortic arch aneurysm-
dc.subjectaortic arch dissection-
dc.subjectbranched stent-graft-
dc.subjectendoleak-
dc.subjectendovascular repair-
dc.titleSafety and Efficacy of Inner Branched Stent-Graft in the Treatment of Aortic Arch Disease: A Systematic Review-
dc.typeArticle-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1177/15266028231197395-
dc.identifier.pmid37646117-
dc.identifier.scopuseid_2-s2.0-85170041652-
dc.identifier.eissn1545-1550-

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats