Aims This article summarizes all available published data with respect to clinical success, complications, and outcomes of endovascular stent–graft placement among patients with descending aortic dissection (AD). Methods and results We performed a meta-analysis of all published series on retrograde endovascular stent–graft placement encompassing � 3 patients with AD. Thirty-nine studies, involving a total of 609 patients, were included. Procedural success was reported in 98.2+ 0.5% of patients. Major complications were reported in 11.1+ 1.4%, with the most dreaded neurologic complications in 2.9 + 0.7% patients. Periprocedural stroke was encountered more frequently than paraplegia (1.9+ 0.6% vs. 0.8+ 0.4%). Overall complications were significantly higher in patients undergoing stent–graft placement for acute AD than in patients with chronic AD (21.7 + 2.8% vs. 9.1+ 2.3%, P ¼ 0.005). The overall 30-day mortality was 5.3+ 0.9%, and was three-fold higher in patients with acute AD when compared with chronic AD (9.8 + 2.2% vs. 3.2+ 1.4%, P ¼ 0.015). In addition, 2.8 + 0.7% of patients died over a mean follow-up period of 19.5 + 7.1 months. Kaplan–Meier analysis yielded overall survival rates of 90.6+ 1.6% at 6 months, 89.9+ 1.7% at 1 year, and 88.8 + 1.9% at 2 years, respectively. Conclusion Endovascular stent–graft placement in type B-AD is technically feasible with success rates of .95% in selected cohort. Although minimally invasive, major complications occurred in 14–18% of patients depending upon the acuity of presentation, with very low incidence of paraplegia. Both, acute and mid-term mortality of this novel treatment strategy appear to favourably compare with surgical treatment but further studies are necessary to compare stent–graft placement with medical treatment in uncomplicated AD.

/pdf/endovascular-stent-graft-placement-in-aortic-dissection-a-1smsbug7ml.pdf

Endovascular stent-graft placement in aortic dissection: a meta-analysis.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)60994-0.pdf

Acute aortic dissection

Acute management of aortobronchial and aortoesophageal fistulas using thoracic endovascular aortic repair.

Secondary surgical procedures after endovascular stent grafting of the thoracic aorta: Successful approaches to a challenging clinical problem

Objective The surgical treatment of aortoesophageal fistulae (AEF) has a high morbidity and mortality rate. We report our experience with the sequential use of endovascular thoracic stentgrafts and cryopreserved aortic homografts for in situ repair of the descending thoracic aorta. Methods In a 7-year period, 6 patients with AEF were treated at our center. After primary endovascular repair in all cases, 4 patients subsequently underwent in situ repair of the descending thoracic aorta with cryopreserved homografts. Long-term antibiotic therapy was given in all cases. Recent clinical status and radiologic findings on follow-up studies of each patient were analyzed. The mean follow-up time was 35 months (range, 2-76). Results Endovascular stentgraft repair was technically successful in all cases. Two patients were not candidates for open surgical repair because of their medical condition; they both died within 8 weeks after discharge from the hospital, 1 from recurrent septic episodes, and the other from upper gastrointestinal bleeding. One of 4 patients who had undergone open surgical repair died 1 year later from upper gastrointestinal bleeding that occurred presumably due to an infectious degeneration of the homograft after secondary infection with a methacillin-resistant Staphyloccocus aureus. In 1 case persistent paraplegia and in another case persistent renal failure occurred. Conclusion The use of cryopreserved homografts is a valuable alternative to in situ repair with prosthetic vascular grafts or extra-anatomic reconstructions in the surgical treatment of AEF. Endovascular stentgraft placement plays a role as a bridging procedure in emergency situations.

Surgical strategy in aortoesophageal fistulae: endovascular stentgrafts and in situ repair of the aorta with cryopreserved homografts.

Purpose:To report the incidence and management of aortoesophageal fistula (AEF) secondary to endovascular stent-graft repair of the descending thoracic aorta.Methods:A retrospective review was cond...

Aortoesophageal Fistula Secondary to Stent-Graft Repair of the Thoracic Aorta

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Aortoesophageal Fistula Secondary to Stent-Graft Repair of the Thoracic Aorta