A Systematic Review and Meta-Analysis of Current Evidence Related to the Impact of Endovascular Repair Timing on Prognosis of Acute Stanford Type B Aortic Dissection.

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  • Author(s): Wang J;Wang J; Bai Z; Bai Z; Chen B; Chen B
  • Source:
    Annals of vascular surgery [Ann Vasc Surg] 2024 Nov; Vol. 108, pp. 47-56. Date of Electronic Publication: 2024 Jul 02.
  • Publication Type:
    Journal Article; Meta-Analysis; Systematic Review
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: Netherlands NLM ID: 8703941 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1615-5947 (Electronic) Linking ISSN: 08905096 NLM ISO Abbreviation: Ann Vasc Surg Subsets: MEDLINE
    • Publication Information:
      Publication: <2007->: Netherlands : Elsevier
      Original Publication: Detroit : [Published by Expansion scientifique française for Annals of Vascular Surgery, Inc. and Association pour la promotion de la chirurgie vasculaire, Paris, c1986-
    • Subject Terms:
      Aortic Aneurysm, Thoracic*/surgery ; Aortic Aneurysm, Thoracic*/diagnostic imaging ; Aortic Dissection*/surgery ; Aortic Dissection*/diagnostic imaging ; Time-to-Treatment* ; Endovascular Aneurysm Repair*/adverse effects ; Endovascular Aneurysm Repair*/instrumentation; Humans ; Acute Disease/therapy ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
    • Abstract:
      Background: The objective of this study was to determine whether thoracic endovascular aortic repair (TEVAR) timing is more beneficial in the acute phase (first 14 days) than in the subacute phase (14-90 days) for the administration of acute Stanford type B aortic dissection (TBAD).
      Methods: A comprehensive literature search was conducted in databases (EMBASE, PubMed and Cochrane Library) until December 2023 to identify studies reporting the results of TEVAR used for patients with acute TBAD. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated utilizing either the random-effects model or the fixed-effects model.
      Results: A total of 25 studies involving 4,827 individuals with TBAD (including 1,609 with subacute TBAD) met our selection criteria. Early results revealed a lower incidence of Ia endoleaks (OR, 1.55; 95% CI, 1.03-2.33; P = 0.04) and aortic ruptures (OR, 2.89; 95% CI, 0.98-8.50; P = 0.05) in subacute TBAD. Apart from these findings, there was little difference in other incidents between the 2 groups. Regarding late outcomes, we observed significantly higher rates of retrograde dissection (OR, 2.12; 95% CI, 1.04-4.34; P = 0.04), distal stent-induced new entry (OR, 2.39; 95% CI, 1.24-4.61; P = 0.009), and reintervention (OR, 1.45; 95% CI, 0.05-1.99; P = 0.02) in acute TBAD than in subacute TBAD, whereas no significant differences were found for other outcomes between the 2 groups. Also, TEVAR appeared to yield comparable results for false lumen thrombosis and true lumen regression in both groups.
      Conclusions: Subacute TBAD repair with TEVAR demonstrates a more effective reduction in adverse event rates compared to immediate treatment in the acute phase.
      (Copyright © 2024 Elsevier Inc. All rights reserved.)
    • Publication Date:
      Date Created: 20240703 Date Completed: 20240914 Latest Revision: 20240930
    • Publication Date:
      20241001
    • Accession Number:
      10.1016/j.avsg.2024.04.025
    • Accession Number:
      38960090