Outcomes After Endovascular Aortic Intervention in Patients With Connective Tissue Disease.

Autor:	Olsson KW; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden., Mani K; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden., Burdess A; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden., Patterson S; Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville., Scali ST; Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville., Kölbel T; Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany., Panuccio G; Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany., Eleshra A; Department of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany., Bertoglio L; Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy., Ardita V; Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy., Melissano G; Division of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy., Acharya A; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom., Bicknell C; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom., Riga C; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom., Gibbs R; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom., Jenkins M; Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom., Bakthavatsalam A; Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle., Sweet MP; Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle., Kasprzak PM; Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany., Pfister K; Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany., Oikonomou K; Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany.; Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany., Heloise T; Department of Vascular Surgery, Centre Hospitalier Universitaire de Lille, Lille, France., Sobocinski J; Department of Vascular Surgery, Centre Hospitalier Universitaire de Lille, Lille, France., Butt T; Vascular Center, Skåne University Hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden., Dias N; Vascular Center, Skåne University Hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden., Tang C; Department of Surgery, Queen Mary Hospital, Hong Kong, China., Cheng SWK; Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong, China., Vandenhaute S; Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium., Van Herzeele I; Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium., Sorber RA; Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Maryland., Black JH 3rd; Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, Baltimore, Maryland., Tenorio ER; Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston., Oderich GS; Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston., Vincent Z; Department of Vascular Surgery, Waikato Hospital, University of Auckland, Hamilton, New Zealand., Khashram M; Department of Vascular Surgery, Waikato Hospital, University of Auckland, Hamilton, New Zealand., Eagleton MJ; Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts., Pedersen SF; Division of Vascular Surgery, Department of Cardiovascular Sugery, Aarhus University Hospital, Aarhus, Denmark., Budtz-Lilly J; Division of Vascular Surgery, Department of Cardiovascular Sugery, Aarhus University Hospital, Aarhus, Denmark., Lomazzi C; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Bissacco D; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Trimarchi S; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.; Department of Clinical and Community Sciences, University of Milan, Milan, Italy., Huerta A; Vascular Surgery Department, CardioVascular Institute, Hospital Clinic, Barcelona, Spain., Riambau V; Vascular Surgery Department, CardioVascular Institute, Hospital Clinic, Barcelona, Spain., Wanhainen A; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.; Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
Jazyk:	angličtina
Zdroj:	JAMA surgery [JAMA Surg] 2023 Aug 01; Vol. 158 (8), pp. 832-839.
DOI:	10.1001/jamasurg.2023.2128
Abstrakt:	Importance: Endovascular treatment is not recommended for aortic pathologies in patients with connective tissue diseases (CTDs) other than in redo operations and as bridging procedures in emergencies. However, recent developments in endovascular technology may challenge this dogma. Objective: To assess the midterm outcomes of endovascular aortic repair in patients with CTD. Design, Setting, and Participants: For this descriptive retrospective study, data on demographics, interventions, and short-term and midterm outcomes were collected from 18 aortic centers in Europe, Asia, North America, and New Zealand. Patients with CTD who had undergone endovascular aortic repair from 2005 to 2020 were included. Data were analyzed from December 2021 to November 2022. Exposure: All principal endovascular aortic repairs, including redo surgery and complex repairs of the aortic arch and visceral aorta. Main Outcomes and Measures: Short-term and midterm survival, rates of secondary procedures, and conversion to open repair. Results: In total, 171 patients were included: 142 with Marfan syndrome, 17 with Loeys-Dietz syndrome, and 12 with vascular Ehlers-Danlos syndrome (vEDS). Median (IQR) age was 49.9 years (37.9-59.0), and 107 patients (62.6%) were male. One hundred fifty-two (88.9%) were treated for aortic dissections and 19 (11.1%) for degenerative aneurysms. One hundred thirty-six patients (79.5%) had undergone open aortic surgery before the index endovascular repair. In 74 patients (43.3%), arch and/or visceral branches were included in the repair. Primary technical success was achieved in 168 patients (98.2%), and 30-day mortality was 2.9% (5 patients). Survival at 1 and 5 years was 96.2% and 80.6% for Marfan syndrome, 93.8% and 85.2% for Loeys-Dietz syndrome, and 75.0% and 43.8% for vEDS, respectively. After a median (IQR) follow-up of 4.7 years (1.9-9.2), 91 patients (53.2%) had undergone secondary procedures, of which 14 (8.2%) were open conversions. Conclusions and Relevance: This study found that endovascular aortic interventions, including redo procedures and complex repairs of the aortic arch and visceral aorta, in patients with CTD had a high rate of early technical success, low perioperative mortality, and a midterm survival rate comparable with reports of open aortic surgery in patients with CTD. The rate of secondary procedures was high, but few patients required conversion to open repair. Improvements in devices and techniques, as well as ongoing follow-up, may result in endovascular treatment for patients with CTD being included in guideline recommendations.
Databáze:	MEDLINE
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