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


RESULTS
We performed a meta-analysis of all published series on retrograde endovascular stent-graft placement encompassing >or=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=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=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.


CONCLUSIONS
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.
Eggebrecht
Holger
H
Department of Cardiology, West-German Heart Center Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany. holger.eggebrecht@uni-essen.de
Nienaber
Christoph A
CA
Neuhäuser
Markus
M
Baumgart
Dietrich
D
Kische
Stephan
S
Schmermund
Axel
A
Herold
Ulf
U
Rehders
Tim C
TC
Jakob
Heinz G
HG
Erbel
Raimund
R
D000208:Acute Disease; D000784:Aortic Dissection / Q000601:surgery*; D017546:Angioscopy / Q000379:methods*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002908:Chronic Disease; D002983:Clinical Competence / Q000592:standards; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome