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2014 ; 3
(3
): 223-33
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Systematic review of outcomes of combined proximal stent-grafting with distal
bare stenting for management of aortic dissection
#MMPMID24967161
Canaud L
; Faure EM
; Ozdemir BA
; Alric P
; Thompson M
Ann Cardiothorac Surg
2014[May]; 3
(3
): 223-33
PMID24967161
show ga
OBJECTIVE: Available data on outcomes of combined proximal stent-grafting with
distal bare stenting for management of aortic dissection are limited. The
objective of this study was to provide a systematic review of outcomes of this
approach. METHODS: Studies involving combined proximal stent-grafting with distal
bare stenting for management of aortic dissection were systematically searched
and reviewed through MEDLINE databases. RESULTS: A TOTAL OF FOUR STUDIES WERE
INCLUDED: 108 patients treated for management of acute (n=54) and chronic (n=54)
aortic dissection. The technical success rate was 95.3% (range, 84-100%). The
30-day mortality rate was 2.7% (range from 0% to 5%). The morbidity rate
occurring within 30 days was 51.8% (range from 0% to 65%) and included stroke
(2.7%), paraplegia (2.7%), retrograde dissection (1.8%), renal failure (14.8%),
severe cardiopulmonary complications (5.5%) and bowel ischemia (0.9%). The
incidence of type I endoleak was 9.2% (10/108). During follow-up, 5 (4.6%) deaths
were related to aortic rupture or aortic repair. Mean re-intervention rate was
12.9%. Two cases (1.9%) of delayed retrograde type A dissection and one case of
aortobronchial fistula (0.9%) were reported. The most common delayed complication
was thoracic stent-graft migration (4.7%). The rate of device failure was 9.2%.
Favorable aortic remodeling was observed: studies reporting midterm follow-up of
the true lumen demonstrated a high rate of both false lumen regression and true
lumen expansion. At 12 months, complete false lumen thrombosis was observed at
the thoracic level in 70.4% and at the abdominal level in 13.5% of patients.
CONCLUSIONS: Combined proximal stent-grafting with distal bare stenting appears
to be a feasible approach for the management of Type B aortic dissection.
Although this approach clearly improved true lumen perfusion and diameter, it
failed to completely suppress false lumen patency. However, it should be
acknowledged that contemporary data on this approach is limited to small studies
with variable results.