In Marfan Syndrome and Related Diseases, STABILISE Technique Should Be Used with Care: Results from a Volumetric Comparative Study of Endovascular Treatment for Aortic Dissection
Abstract
:1. Introduction
2. Materials and Methods
2.1. Population
2.2. Perioperative Approach
2.3. TEVAR Technique
2.4. STABILISE Technique
2.4.1. Distal Aortic Bare-Stent Deployment
2.4.2. Management of Visceral Arteries
2.4.3. Balloon Dilatation of the Bare Stent
2.5. Epidemiological Data
2.6. Radiological Data
2.7. Diameter Analysis
2.8. Volume Analysis
2.9. FL Status
2.10. Entry Tear
2.11. Endpoints
2.12. Statistical Analysis
3. Results
3.1. Population (Figure 2)
3.2. FL Status
3.3. Anatomical Results
3.3.1. Diameter Analysis
3.3.2. Volume Analysis
Results at 1 Year
Results at the End of the Follow-Up
3.3.3. Subgroup Study: TEVAR/STABILISE: Volume Analysis (Table 3)
At 1 Year | True Lumen | False Lumen | Total | ||||||
---|---|---|---|---|---|---|---|---|---|
Group | non HTAD | HTAD | p-value | Non-HTAD | HTAD | p-value | Non-HTAD | HTAD | p-value |
STABILISE (−) % mean (SD) | 45.7 (±39.7) | 47.0 (±22.5) | 0.77 | −17.5 (±43.3) | 6.6 (±73.0) | 0.482 | 1.7 (±20.3) | 16.7 (±30.1) | 0.263 |
STABILISE (+) % mean (SD) | 98.3 (±38.9) | 160.1 (±52.3) | 0.029 | −74.9 (±15.2) | −66.3 (±21.9) | 0.694 | −3.1 (±19.1) | 26.2 (±16.4) | 0.009 |
p-value | 0.011 | <0.001 | 0.001 | 0.006 | 0.447 | 0.277 | |||
Last Follow-Up | True Lumen | False Lumen | Total | ||||||
Group | Non-HTAD | HTAD | p-value | Non-HTAD | HTAD | p-value | Non-HTAD | HTAD | p-value |
STABILISE (−) % mean (SD) | 71.2 (±59.5) | 58.6 (±38.4) | 0.967 | −17.6 (±52.4) | −13.3 (±39.2) | 0.432 | 12.3 (±40.0) | 17.1 (±17.6) | 0.773 |
STABILISE (+) % mean (SD) | 89.2 (±29.4) | 189.5 (±92.5) | 0.042 | −71.2 (±22.8) | −63.4 (±24.2) | 0.648 | 2.7 (±22.5) | 35.7 (±17.2) | 0.042 |
p-value | 0.17 | 0.004 | 0.042 | 0.026 | 1 | 0.128 |
Results at 1 Year
Results at the End of the Follow-Up
3.4. Risk Factors for Unfavorable Anatomical Evolution in HTAD Group
3.5. Morbi-Mortality
3.5.1. Perioperative Morbidity and Mortality
3.5.2. Long-Term Morbidity and Mortality
3.6. Reoperations
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
MFS | marfan syndrome |
HTAD | Heritable Thoracic Aortic Disease |
TEVAR | thoracic endovascular aortic repair |
AD | aortic dissection |
TL | True lumen |
FL | false lumen |
NET | new entry tears |
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Demographic Data | HTAD n = 17 | Non-HTAD n = 22 | p-Value |
---|---|---|---|
Age, mean (SD) | 40 (±12) | 57 (±8.7) | <0.01 |
Male sex, n (%) | 13 (77) | 20 (91) | 0.374 |
Hypertension, n (%) | 10 (58.8) | 21 (95.5) | 0.013 |
Smokers, n (%) | 10 (58.8) | 11 (50.0) | 0.584 |
Diabetis mellitus, n (%) | 1 (5.9) | 1 (4.5) | 1.000 |
Dyslipidemia, n (%) | 3 (17.6) | 5 (22.7) | 1.000 |
Coronaropathy, n (%) | 0 (0.0) | 1 (4.5) | 1.000 |
Valvulopathy, n (%) | 4 (23.5) | 1 (4.5) | 0.147 |
LVEF <55%, n (%) | 2 (11.8) | 1 (4.5) | 0.570 |
COPD, n (%) | 0 (0.0) | 2 (9.1) | 0.495 |
Renal failure, n (%) | 0 (0.0) | 1 (4.5) | 1.000 |
Anticoagulants, n (%) | 5 (29.4) | 11 (50.0) | 0.195 |
Aortic surgery | |||
Type A aortic dissection, n (%) | 8 (47.1) | 13 (59.1) | 0.053 |
Valve replacement, n (%) | 15 (88.2) | 4 (18.2) | 0.140 |
Aortic replacement, n (%) | 2 (11.8) | 14 (63.6) | 0.570 |
Treatment phase | |||
Acute and Sub-Acute phase (14–90 days), n (%) | 9 (52.9) | 7 (31.8) | 0.332 |
Chronic phase> 90 days, n (%) | 8 (47.1) | 15 (68.2) | 0.053 |
Indication | |||
Rupture, n (%) | 0 (0%) | 0(0%) | 1 |
Malperfusion syndrome, n (%) | 5 (29.4%) | 4(18.2%) | 0.457 |
Refractory pain, n (%) | 2 (11.8%) | 0 (0%) | 0.457 |
Refractory hypertension, n (%) | 0 (0%) | 3 (13.6%) | 0.457 |
Rapid aortic growth > 5 mm/6 month, n (%) | 5 (29.4%) | 7(31.8%) | 0.457 |
Aneurysmal evolution, n (%) | 5 (29.4%) | 8 (36.4%) | 0.457 |
HTAD n = 17 | Non-HTAD n = 22 | p-Value | |
---|---|---|---|
Peoximal neck management surgery, n (%) | 10 (58.8) | 16 (72.7) | 0.728 |
IA debranching, n (%) | 3 (17.6) | 12 (54.5) | 0.036 |
LCCA debranching, n (%) | 4 (23.5) | 14 (63.6) | 0.027 |
LSA debranching, n (%) | 10 (58.8) | 16 (72.7) | 0.728 |
3 supra-aortic trunks debranching, n (%) | 3 (17.6) | 11 (50.0) | 0.065 |
Proximal landing zone (Ishimaru) | |||
Z0 n (%) | 2 (11.8) | 11 (50.0) | 0.067 |
Z1 n (%) | 1 (5.9) | 3 (13.6) | 1.000 |
Z2 n (%) | 7 (41.2) | 3 (13.6) | 0.022 |
Z3 n (%) | 7 (41.1) | 5 (22.8) | 0.216 |
Proximal neck length (mm), mean (SD) | 14.7 (±14.6) | 28.5 (±22.9) | 0.067 |
Proximal neck diameter (mm), mean (SD) | 29.1 (±9.0) | 32.1 (±7.6) | 0.055 |
STABILISE, n (%) | 8 (47.1) | 7 (31.8) | 0.332 |
Length of cover (mm), mean (SD) | 199.4 (±52.8) | 194.1 (±50.5) | 0.989 |
Number of entry tears, mean (SD) | 5.8 (±3.1) | 4.0 (±2.3) | 0.052 |
Diameter of the main entry tears, mean (SD) | 13.6(±7.5) | 15.1 (±11.4) | 0.908 |
Location of the main entry tears | |||
Segment 2 | 1 (5.9) | 4 (18.2) | 0.267 |
Segment 3 | 13 (76.5) | 10 (45.5) | 0.267 |
Segment 4 | 2 (11.8) | 6 (27.3) | 0.267 |
Segment 5 | 1 (5.9) | 2 (9.1) | 0.267 |
HTAD Group | Secondary Procedure | Time to Reintervention (Months) |
---|---|---|
Patient 1 | Hybrid treatment of the throraco abdominal aorta for aneurysmal progression | 18 |
Patient 2 | Type A Aortic dissection and distal TEVAR for aortic rupture | 57 |
Patient 3 | Type A Aortic dissection and TEVAR for aneurysmal evolution | 1 |
Patient 4 | CT embolization, TEVAR, Iliac branch stent graft for type Ib endoleak and aneurysmal progression | 47 |
Patient 5 | TEVAR + CT embolisation for aneurysmal progression | 37 |
Patient 6 | TEVAR for aneurysmal progression | 16 |
Patient 7 | TEVAR for aneurysmal progression | 5 |
Non HTAD group | Secondary procedure | Time to reintervention (months) |
Patient 1 | Proximal neck embolisation for type Ia endoleak | 2 |
Patient 2 | Hybrid treatment of the aortic arch for aneurysmal progression | 31 |
Patient 3 | EVAR leg angioplasty for lower limb claudication | 41 |
Patient 4 | Intercarotid bypass for cerebral malperfusion | 49 |
Patient 5 | Hybrid aortic arch treatment for aorto-bronchial fistula | 7 |
Patient 6 | TEVAR for aneurysmal evolution | 23 |
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Azogui, R.; Porto, A.; Castelli, M.; Omnes, V.; De Masi, M.; Bartoli, M.; Piquet, P.; Gariboldi, V.; Busa, T.; Jacquier, A.; et al. In Marfan Syndrome and Related Diseases, STABILISE Technique Should Be Used with Care: Results from a Volumetric Comparative Study of Endovascular Treatment for Aortic Dissection. J. Clin. Med. 2023, 12, 4378. https://doi.org/10.3390/jcm12134378
Azogui R, Porto A, Castelli M, Omnes V, De Masi M, Bartoli M, Piquet P, Gariboldi V, Busa T, Jacquier A, et al. In Marfan Syndrome and Related Diseases, STABILISE Technique Should Be Used with Care: Results from a Volumetric Comparative Study of Endovascular Treatment for Aortic Dissection. Journal of Clinical Medicine. 2023; 12(13):4378. https://doi.org/10.3390/jcm12134378
Chicago/Turabian StyleAzogui, Ron, Alizee Porto, Maxime Castelli, Virgile Omnes, Mariangela De Masi, Michel Bartoli, Philippe Piquet, Vlad Gariboldi, Tiffany Busa, Alexis Jacquier, and et al. 2023. "In Marfan Syndrome and Related Diseases, STABILISE Technique Should Be Used with Care: Results from a Volumetric Comparative Study of Endovascular Treatment for Aortic Dissection" Journal of Clinical Medicine 12, no. 13: 4378. https://doi.org/10.3390/jcm12134378