Intentional Targeted False Lumen Occlusion after Aortic Dissection: A Systematic Review of the Literature
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Intentional Targeted False Lumen Occlusion after Aortic Dissection: A Systematic Review of the Literature. / Spanos, Konstantinos; Kölbel, Tilo; Rohlffs, Fiona; Heidemann, Franziska; Giannoukas, Athanasios D; Debus, Sebastian E; Tsilimparis, Nikolaos.
In: ANN VASC SURG, Vol. 56, 04.2019, p. 317-329.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Intentional Targeted False Lumen Occlusion after Aortic Dissection: A Systematic Review of the Literature
AU - Spanos, Konstantinos
AU - Kölbel, Tilo
AU - Rohlffs, Fiona
AU - Heidemann, Franziska
AU - Giannoukas, Athanasios D
AU - Debus, Sebastian E
AU - Tsilimparis, Nikolaos
N1 - Copyright © 2018 Elsevier Inc. All rights reserved.
PY - 2019/4
Y1 - 2019/4
N2 - BACKGROUND: Residual patent false lumen (FL) after chronic type B aortic dissection (cTBAD) or type A aortic dissection (TAAD) treatment is independently associated with poor long-term outcomes. The aim of our study was to present endovascular techniques and the existing experience with targeted FL thrombosis after cTBAD or TAAD treatment.MATERIAL AND METHODS: A systematic review was performed (Preferred Reporting Items for Systematic reviews and Meta-Analyses) searching in MEDLINE, CENTRAL, and Cochrane databases for studies reporting on targeted FL occlusion after cTBAD or TAAD treatment.RESULTS: One hundred one patients either after open repair of a TAAD (n = 40; 3 case reports and 3 retrospective studies) or after cTBAD (n = 61; 13 case reports and 6 retrospective studies) underwent an endovascular procedure for intentional FL occlusion (2 studies reported on both procedures). Among TAAD patients, 27 of 40 (68%) had previous open repair, whereas 48 of 61 (79%) with cTBAD had a previous endovascular repair. Thirty-one (78%) patients with TAAD and fifty-one (83%) with cTBAD were treated electively. Four main techniques were used: (1) the candy-plug (19/101), (2) the knickerbocker (3/91), (3) the "cork in the bottle neck" technique (2/101), and (4) FL embolization with combined use of coils, onyx, plugs, and glue (77/101). The technical success rate was 100%, with a 30-day mortality rate of 2.5% (1/40) in TAAD and 0% in cTBAD patients. During follow-up (ranging: 2 to 63 months), the mortality rate was 0% (0/31) and 7.1% (4/61) in TAAD and cTBAD patients, respectively. The FL remained completely thrombosed in 78% (31/40) of TAAD and 62% (38/61) of cTBAD patients, whereas it was partially thrombosed in 3 and 2 patients, respectively (no report for 22 patients).CONCLUSIONS: Intentional FL occlusion seems to be a feasible less invasive approach after cTBAD or TAAD treatment, which is not broadly used. Future larger studies with longer follow-up duration may demonstrate the apparent benefit in terms of aortic remodeling or stabilization of the disease progression.
AB - BACKGROUND: Residual patent false lumen (FL) after chronic type B aortic dissection (cTBAD) or type A aortic dissection (TAAD) treatment is independently associated with poor long-term outcomes. The aim of our study was to present endovascular techniques and the existing experience with targeted FL thrombosis after cTBAD or TAAD treatment.MATERIAL AND METHODS: A systematic review was performed (Preferred Reporting Items for Systematic reviews and Meta-Analyses) searching in MEDLINE, CENTRAL, and Cochrane databases for studies reporting on targeted FL occlusion after cTBAD or TAAD treatment.RESULTS: One hundred one patients either after open repair of a TAAD (n = 40; 3 case reports and 3 retrospective studies) or after cTBAD (n = 61; 13 case reports and 6 retrospective studies) underwent an endovascular procedure for intentional FL occlusion (2 studies reported on both procedures). Among TAAD patients, 27 of 40 (68%) had previous open repair, whereas 48 of 61 (79%) with cTBAD had a previous endovascular repair. Thirty-one (78%) patients with TAAD and fifty-one (83%) with cTBAD were treated electively. Four main techniques were used: (1) the candy-plug (19/101), (2) the knickerbocker (3/91), (3) the "cork in the bottle neck" technique (2/101), and (4) FL embolization with combined use of coils, onyx, plugs, and glue (77/101). The technical success rate was 100%, with a 30-day mortality rate of 2.5% (1/40) in TAAD and 0% in cTBAD patients. During follow-up (ranging: 2 to 63 months), the mortality rate was 0% (0/31) and 7.1% (4/61) in TAAD and cTBAD patients, respectively. The FL remained completely thrombosed in 78% (31/40) of TAAD and 62% (38/61) of cTBAD patients, whereas it was partially thrombosed in 3 and 2 patients, respectively (no report for 22 patients).CONCLUSIONS: Intentional FL occlusion seems to be a feasible less invasive approach after cTBAD or TAAD treatment, which is not broadly used. Future larger studies with longer follow-up duration may demonstrate the apparent benefit in terms of aortic remodeling or stabilization of the disease progression.
KW - Aneurysm, Dissecting/diagnostic imaging
KW - Aortic Aneurysm/diagnostic imaging
KW - Aortography/methods
KW - Chronic Disease
KW - Computed Tomography Angiography
KW - Embolization, Therapeutic/adverse effects
KW - Endovascular Procedures/adverse effects
KW - Humans
KW - Postoperative Complications/etiology
KW - Risk Factors
KW - Thrombosis
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.avsg.2018.08.086
DO - 10.1016/j.avsg.2018.08.086
M3 - SCORING: Review article
C2 - 30496905
VL - 56
SP - 317
EP - 329
JO - ANN VASC SURG
JF - ANN VASC SURG
SN - 0890-5096
ER -
