Lei Zhang1, Zhiqing Zhao2, Yanqing Chen1, Yudong Sun1, Junmin Bao1, Zaiping Jing3, Jian Zhou1. 1. Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China. 2. Department of Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China. 3. Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: xueguanky@163.com.
Abstract
OBJECTIVES: Thoracic endovascular aortic repair has been chosen as a less-invasive alternative to open surgery for the treatment of aortic dissections; however, the advantages have been challenged by the postoperative reintervention during the follow-up period. This study aimed at evaluating the incidence, reasons, and potential risk factors for reintervention. METHODS: Studies reporting reintervention after endovascular repair were identified by searching PubMed and Embase in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines, and by reviewing the reference lists of retrieved articles. Sensitivity analysis and subgroup analyses were performed to determine the sources of heterogeneity. Funnel plot and Egger's test were used to determine the publication bias. RESULTS: A total of 27 studies encompassing 2403 patients with aortic dissection were identified. The pooled incidence of reintervention after endovascular repair was 15% (95% confidence interval, 12-19) during 33.7 months of follow-up. The 3 most common reasons for reintervention were endoleak (33.2%), false lumen perfusion and aortic dilation (19.8%), and new dissection (6.9%). The potential factors for reintervention were the mean age of onset and diabetes mellitus determined by performing a single meta-regression analysis (P < .001 and .044, respectively). CONCLUSIONS: Current data suggest that the incidence of reintervention after endovascular therapy is relatively high during midterm follow-up. Advanced age of onset is a risk factor and diabetes mellitus is a protective factor of reintervention after endovascular therapy. The possible mechanism that diabetes mellitus protects patients from reintervention should be explored further.
OBJECTIVES: Thoracic endovascular aortic repair has been chosen as a less-invasive alternative to open surgery for the treatment of aortic dissections; however, the advantages have been challenged by the postoperative reintervention during the follow-up period. This study aimed at evaluating the incidence, reasons, and potential risk factors for reintervention. METHODS: Studies reporting reintervention after endovascular repair were identified by searching PubMed and Embase in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines, and by reviewing the reference lists of retrieved articles. Sensitivity analysis and subgroup analyses were performed to determine the sources of heterogeneity. Funnel plot and Egger's test were used to determine the publication bias. RESULTS: A total of 27 studies encompassing 2403 patients with aortic dissection were identified. The pooled incidence of reintervention after endovascular repair was 15% (95% confidence interval, 12-19) during 33.7 months of follow-up. The 3 most common reasons for reintervention were endoleak (33.2%), false lumen perfusion and aortic dilation (19.8%), and new dissection (6.9%). The potential factors for reintervention were the mean age of onset and diabetes mellitus determined by performing a single meta-regression analysis (P < .001 and .044, respectively). CONCLUSIONS: Current data suggest that the incidence of reintervention after endovascular therapy is relatively high during midterm follow-up. Advanced age of onset is a risk factor and diabetes mellitus is a protective factor of reintervention after endovascular therapy. The possible mechanism that diabetes mellitus protects patients from reintervention should be explored further.
Authors: Sidhant Singh; Abedalaziz O Surkhi; Sven Z C P Tan; Matti Jubouri; Damian M Bailey; Ian Williams; Mohamad Bashir Journal: Front Cardiovasc Med Date: 2022-06-29
Authors: Mario D'Oria; Indrani Sen; Courtney N Day; Jay Mandrekar; Salome Weiss; Thomas C Bower; Gustavo S Oderich; Philip P Goodney; Randall R DeMartino Journal: J Vasc Surg Date: 2020-07-30 Impact factor: 4.268