Endovascular stent–graft placement in aortic dissection: a meta-analysis

Abstract

Aims 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). Methods and results We performed a meta-analysis of all published series on retrograde endovascular stent–graft placement encompassing ≥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. Conclusion 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.