Endovascular Repair of Type B Aortic Dissection Long-Term Results of the Randomized Investigation of Stent Grafts in Aortic Dissection Trial
01 Aug 2013-Circulation-cardiovascular Interventions (Circ Cardiovasc Interv)-Vol. 6, Iss: 4, pp 407-416
TL;DR: In this study of survivors of type B aortic dissection, TEVAR in addition to optimal medical treatment is associated with improved 5-year aorta-specific survival and delayed disease progression and should be considered to improve late outcome.
Abstract: Background—Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown. Methods and Results—A total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR (n=72) versus optimal medical treatment alone (n=68) were analyzed retrospectively for aorta-specific, all-cause outcomes, and disease progression using landmark statistical analysis of years 2 to 5 after index procedure. Cox regression was used to compare outcomes between groups; all analyses are based on intention to treat. The risk of all-cause mortality (11.1% versus 19.3%; P=0.13), aorta-specific mortality (6.9% versus 19.3%; P=0.04), and progression (27.0% versus 46.1%; P=0.04) after 5 years was lower with TEVAR than with optimal medical treatment alone. Landmark analysis suggested a benefit of TEVAR for all end points between 2 and 5 years; for example, for...
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TL;DR: Autores/Miembros del Grupo de Trabajo: Raimund Erbel ( coordinador) (Alemania), Victor Aboyans (Coordinado) ( Francia), Catherine Boileau (Francia), Eduardo Bossone (Italia), Roberto Di Bartolomeo (It Italy), Holger Eggebrecht (AleGermany)
Abstract: Autores/Miembros del Grupo de Trabajo: Raimund Erbel (Coordinador) (Alemania), Victor Aboyans (Coordinador) (Francia), Catherine Boileau (Francia), Eduardo Bossone (Italia), Roberto Di Bartolomeo (Italia), Holger Eggebrecht (Alemania), Arturo Evangelista (Espana), Volkmar Falk (Suiza), Herbert Frank (Austria), Oliver Gaemperli (Suiza), Martin Grabenwoger (Austria), Axel Haverich (Alemania), Bernard Iung (Francia), Athanasios John Manolis (Grecia), Folkert Meijboom (Paises Bajos), Christoph A. Nienaber (Alemania), Marco Roffi (Suiza), Herve Rousseau (Francia), Udo Sechtem (Alemania), Per Anton Sirnes (Noruega), Regula S. von Allmen (Suiza) y Christiaan J.M. Vrints (Belgica)
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TL;DR: The management of Descending Thoracic Aorta Diseases: Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS) as mentioned in this paper is a guideline for the management of thoracic aorta diseases.
697 citations
TL;DR: Presenting symptoms and physical findings of AAD have not changed significantly and more patients in both groups were managed with interventional procedures: surgery in type A and endovascular therapy in type B.
680 citations
Cites background from "Endovascular Repair of Type B Aorti..."
...A single randomized study demonstrated improved survival for uncomplicated type B patients at 5 years post-dissection compared with those who received medical therapy alone (10,19)....
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TL;DR: In this article, the authors present a three-dimensional CT image of the abdominal aortic aneurysm with the aim to evaluate the impact of the aorta dissection on the patient.
Abstract: 3D
: three-dimensional
AAA
: abdominal aortic aneurysm
AAS
: acute aortic syndrome
ACC
: American College of Cardiology
ACE
: angiotensin-converting enzyme
AD
: Aortic dissection
ADAM
: Aneurysm Detection and Management
AHA
: American Heart Association
AJAX
: Amsterdam Acute Aneurysm
AO
: aorta
AOS
: aneurysms-osteoarthritis syndrome
ARCH
: Aortic Arch Related Cerebral Hazard
ATS
: arterial tortuosity syndrome
BAV
: bicuspid aortic valve
BSA
: body surface area
CI
: confidence interval
CoA
: coarctation of the aorta
CPG
: Committee for Practice Guidelines
CSF
: cerebrospinal fluid
CT
: computed tomography
DREAM
: Dutch Randomized Aneurysm Management
DUS
: Doppler ultrasound
EBCT
: electron beam computed tomography
ECG
: electrocardiogram
EDS
: Ehlers-Danlos syndrome
EDSIV
: Ehlers-Danlos syndrome type IV
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
EVAR
: endovascular aortic repair
FDG
: 18F-fluorodeoxyglucose
FL
: false lumen
GCA
: giant cell arteritis
GERAADA
: German Registry for Acute Aortic Dissection Type A
IAD
: iatrogenic aortic dissection
IMH
: intramural haematoma
INSTEAD
: Investigation of Stent Grafts in Patients with type B Aortic Dissection
IRAD
: International Registry of Aortic Dissection
IVUS
: intravascular ultrasound
LCC
: left coronary cusp
LDS
: Loeys-Dietz syndrome
MASS
: Multicentre Aneurysm Screening Study
MESA
: Multi-Ethnic Study of Atherosclerosis
MPR
: multiplanar reconstruction
MRA
: magnetic resonance angiography
MRI
: magnetic resonance imaging
MSCT
: multislice computed tomography
NA
: not applicable
NCC
: non-coronary cusp
ns-TAAD
: non-syndromic thoracic aortic aneurysms and dissection
OR
: odds ratio
OVER
: Open Versus Endovascular Repair
OxVasc
: Oxford Vascular study
PARTNER
: Placement of AoRtic TraNscathetER Valves
PAU
: penetrating aortic ulcer
PICSS
: Patent Foramen Ovale in Cryptogenic Stroke study
PET
: positron emission tomography
RCCA
: right common carotid artery
RCC
: right coronary cusp
RCT
: randomized, clinical trial
RR
: relative risk
SIRS
: systemic inflammatory response
SMC
: smooth muscle cell
TAA
: thoracic aortic aneurysm
TAAD
: thoracic aortic aneurysms and dissection
TAI
: traumatic aortic injury
TEVAR
: thoracic endovascular aortic repair
TGF
: transforming growth factor
TI
: separate thyroid artery (A. thyroidea)
TL
: true lumen
TOE
: transoesophageal echocardiography
TS
: Turner Syndrome
TTE
: transthoracic echocardiography
UKSAT
: UK Small Aneurysm Trial
ULP
: ulcer-like projection
WARSS
: Warfarin-Aspirin Recurrent Stroke Study
Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.
A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions …
639 citations
References
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TL;DR: This work is presented for the first time to the Ad Hoc Committee for Standardized Reporting Practices in Vascular Surgery of The Society for Vascular surgery/American Association forVascular Surgery.
1,564 citations
TL;DR: Endovascular repair was associated with increased rates of graft-related complications and reinterventions and was more costly than open surgical repair, but no differences were seen in total mortality or aneurysm-related mortality in the long term.
Abstract: Results The 30-day operative mortality was 1.8% in the endovascular-repair group and 4.3% in the open-repair group (adjusted odds ratio for endovascular repair as compared with open repair, 0.39; 95% confidence interval [CI], 0.18 to 0.87; P = 0.02). The endovascular-repair group had an early benefit with respect to aneurysm-related mortality, but the benefit was lost by the end of the study, at least partially because of fatal endo graft ruptures (adjusted hazard ratio, 0.92; 95% CI, 0.57 to 1.49; P = 0.73). By the end of follow-up, there was no significant difference between the two groups in the rate of death from any cause (adjusted hazard ratio, 1.03; 95% CI, 0.86 to 1.23; P = 0.72). The rates of graft-related complications and reinterventions were higher with endovascular repair, and new complications occurred up to 8 years after randomization, contributing to higher overall costs. Conclusions In this large, randomized trial, endovascular repair of abdominal aortic aneurysm was associated with a significantly lower operative mortality than open surgical repair. However, no differences were seen in total mortality or aneurysm-related mortality in the long term. Endovascular repair was associated with increased rates of graft-related complications and reinterventions and was more costly. (Current Controlled Trials number, ISRCTN55703451.)
1,235 citations
"Endovascular Repair of Type B Aorti..." refers result in this paper
...Such long-term stability in patients with stented aorta may be dissection specific and explained by healing, and thereby different from less encouraging experience in aneurysmatic disease.(28) Although elective crossover and endovascular reintervention were generally safe, corroborating observations in chronic type B dissection,(14) emergency TEVAR portends considerable mortality(29,30); emergencies may in fact be avoided by both imaging surveillance and elective TEVAR....
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TL;DR: Stent-graft coverage of the primary entry tear may be a promising new treatment for selected patients with acute aortic dissection and requires further evaluation, however, to assess its therapeutic potential fully.
Abstract: Background The standard treatment for acute aortic dissection is either surgical or medical therapy, depending on the morphologic features of the lesion and any associated complications. Irrespective of the form of treatment, the associated mortality and morbidity are considerable. Methods We studied the placement of endovascular stent–grafts across the primary entry tear for the management of acute aortic dissection originating in the descending thoracic aorta. We evaluated the feasibility, safety, and effectiveness of transluminal stent–graft placement over the entry tear in 4 patients with acute type A aortic dissections (which involve the ascending aorta) and 15 patients with acute type B aortic dissections (which are confined to the descending aorta). Dissections involved aortic branches in 14 of the 19 patients (74 percent), and symptomatic compromise of multiple branch vessels was observed in 7 patients (37 percent). The stent–grafts were made of self-expanding stainless-steel covered with woven po...
1,158 citations
1,124 citations
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01 Jan 1980TL;DR: Flow patterns and wall shear stress in arteries I Straight tubes and flow instability, and flow in collapsible tubes.
Abstract: 1. Physiological introduction 2. Propagation of the pressure pulse 3. Flow patterns and wall shear stress in arteries I Straight tubes 4. Flow patterns and wall shear stress in arteries II. Curved tubes 5. Flow patterns and wall shear stress in arteries III. Branched tubes and flow instability 6. Flow in collapsible tubes.
1,048 citations