Endovascular Treatment of Degenerative Aneurysms Involving Only the Descending Thoracic Aorta : Systematic Review and Meta-analysis

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Biancari , F , Mariscalco , G , Mariani , S , Saari , P , Satta , J & Juvonen , T 2016 , ' Endovascular Treatment of Degenerative Aneurysms Involving Only the Descending Thoracic Aorta : Systematic Review and Meta-analysis ' Journal of Endovascular Therapy , vol. 23 , no. 2 , pp. 387-392 . DOI: 10.1177/1526602815626560

Title: Endovascular Treatment of Degenerative Aneurysms Involving Only the Descending Thoracic Aorta : Systematic Review and Meta-analysis
Author: Biancari, Fausto; Mariscalco, Giovanni; Mariani, Silvia; Saari, Petri; Satta, Jari; Juvonen, Tatu
Contributor: University of Helsinki, Clinicum
Date: 2016-04
Language: eng
Number of pages: 6
Belongs to series: Journal of Endovascular Therapy
ISSN: 1526-6028
URI: http://hdl.handle.net/10138/161342
Abstract: Purpose: To determine the efficacy of thoracic endovascular aortic repair (TEVAR) for degenerative aneurysm involving only the descending thoracic aorta (DTAA). Methods: An English-language literature review was performed through PubMed, Scopus, and Google Scholar to identify any study evaluating the outcomes of TEVAR for DTAA. The main endpoints of this analysis were all-cause 30-day and late postoperative mortality. Secondary outcome measures were procedure success, vascular access complications, paraplegia, stroke, early endoleaks during the index hospitalization, aneurysm-related death, reinterventions, and conversion to open repair. To control for the anticipated heterogeneity among small observational studies, absolute values and means were pooled using random effects models; the results are expressed as pooled proportions, means, or risk ratio (RR) with 95% confidence intervals (CIs). Results: Eleven studies reporting on 673 patients (mean age 72.6 years, mean aneurysm diameter 62.9 cm) with DTAA were selected for the analysis. Technical success was reported in 91.0% of patients, and vascular access complications requiring repair were encountered in 9.7% of cases. Pooled overall 30-day, 1-year, 2-year, and 3-year survival rates were 96.0%, 80.3%, 77.3%, and 74.0%, respectively. Five studies compared the results of TEVAR after elective (n=151) and urgent/emergent procedure (n=77); the latter was a predictor of 30-day mortality (17.1% vs 1.8%, RR 3.83, 95% CI 1.18 to 12.40, p=0.025). Paraplegia occurred in 3.2% of patients and was permanent in 1.4% of patients. The stroke rate was 2.7%. Early type I endoleak was observed in 7.3%, type II endoleak in 2.0%, and type III in 1.2% of patients. The mean follow-up of 9 studies was 22.3 months. At 3 years, freedom from reintervention was 90.3%. Death secondary to aneurysm rupture and/or fistula was reported in 3.2% of patients. Conclusion: Current results indicate that TEVAR for DTAA can be performed with rather high technical success, low postoperative morbidity, and good 3-year survival.
Subject: aneurysm
descending aorta
mortality
paraplegia
reintervention
stent-graft
stroke
thoracic aortic aneurysm
thoracic endovascular aortic repair
VASCULAR COMPLICATIONS
NATURAL-HISTORY
OPEN SURGERY
STENT-GRAFT
OPEN REPAIR
MULTICENTER
EXPERIENCE
TRIAL
3126 Surgery, anesthesiology, intensive care, radiology
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