Thoracic endovascular repair versus medical management for acute uncomplicated type B aortic dissection
| Autor: | Jeffrey A. Goldstein, Jad Omran, Deepak L. Bhatt, Christopher J. White, Ehtisham Mahmud, Nilesh J. Goswami, William A. Gray, Ashraf Al-Dadah, Tariq Enezate, Rossella Fattori, Mitul Patel |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Time Factors 030204 cardiovascular system & hematology Blood Vessel Prosthesis Implantation 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Humans Medicine Radiology Nuclear Medicine and imaging In patient 030212 general & internal medicine Aortic dilation Aortic rupture Aged Aortic dissection Aortic Aneurysm Thoracic business.industry Type B aortic dissection Endovascular Procedures Treatment options Cardiovascular Agents General Medicine Middle Aged medicine.disease Confidence interval Surgery Aortic Dissection Treatment Outcome Background current Acute Disease Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Catheterization and Cardiovascular Interventions. 91:1138-1143 |
| ISSN: | 1522-1946 |
| DOI: | 10.1002/ccd.27406 |
| Popis: | Background Current treatment options and outcomes for acute uncomplicated thoracic Type-B aortic dissection (TBAD) remain unclear between medical management (MED) and thoracic endovascular aortic repair (TEVAR). In this study we aim to compare both strategies in terms of all-cause mortality, aortic dilation, and aortic rupture. Methods MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were queried from January 1990 through March 2017. Only studies comparing TEVAR to MED for acute uncomplicated TBAD were included. Random-effects meta-analysis was used to pool outcomes across studies. Study outcomes included short (1 month), intermediate (1 year), and mid-term (2-5 year) all-cause mortality. Additional outcomes included aortic dilation and rupture at 1 year. Results A total of 1,960 patients (64.3 years; 75.8% male) were included from six studies (one prospective and five retrospective). No difference was observed in short-term (odd ratio [OR] 0.73 with 95% confidence interval [CI] 0.47 to 1.12, P = 0.15), intermediate (OR 0.99 with 95% CI 0.56 to 1.73, P = 0.96), or mid-term all-cause mortality (OR 1.12 with 95% CI 0.54 to 2.32, P = 0.75). No difference in aortic dilation with either modality was noted at 1-year (OR 1.11 with 95% CI 0.76 to 1.64, P = 0.59). TEVAR was associated with a significantly lower 1-year risk of aortic rupture (OR 2.49 with 95% CI 1.23 to 5.06, P = 0.01). Conclusion There were no short, intermediate, or mid-term differences in mortality between TEVAR or MED in patients with acute uncomplicated TBAD. Although the dilation rate was similar between both groups, TEVAR was associated with lower likelihood of aortic rupture at 1 year. |
| Databáze: | OpenAIRE |
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