Effectiveness and Safety of Endovascular Aortic Repair and Open Operation in Treatment of Acute Stanford Type B Aortic Dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Kerui , LI Xinxi , WANG Yang ,  LUO Jun , XIN Hai , WANG Ke , TIAN Ye , BAI Chao

Department of Vascular and Thyroid Surgery， The First Affiliated Hospital of Xinjiang Medical University， Urumqi 830054， Xinjiang Uygur Autonomous Region， China;

Corresponding author：

LUO Jun, Email: xmuluo@163.com

Keywords：

Acute Stanford type B aortic dissection; Endovascular aortic repair; Open operation; Complication

Video：

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Objective 　To systematic evaluate the efficacy and safety of the endovascular aortic repair （endovascular stent placement） and open operation in treatment of acute Stanford type B aortic dissection.
Methods 　The literatures about clinical controlled trials of endovascular aortic repair and open operation in treatment of acute Stanford type B aortic dissection that were included in CNKI， Wanfang data， VIP， Cochrane Central Register of Controlled Trials of the Cochrane Library， OVID， Pubmed Medline， EBSCO， EMBASE， Springer Link，Science Direct， and other databases from January 1991 to January 2013 were retrieved by computer. RevMan 5.1 software were used to analyze the clinical trial data.
Results 　Eight trials （5 618 patients with acute Stanford type B aortic dissection） were included in the analysis.There was statistically significant difference of the 30 d mortality after operation between the endovascular repair group and the open operation group， which endovascular repair group was significantly better than the open operation group
〔OR=0.55，95% CI （0.46-0.65）， P＜0.000 01〕. In addition， there were significant difference between the incidence of
stroke 〔OR=0.57， 95% CI （0.39-0.84）， P=0.005〕， respiratory failure 〔OR=0.64， 95% CI （0.53-0.78）， P＜0.000 01〕， and cardiac complications 〔OR=0.49，95% CI （0.38-0.64），P＜0.000 01〕，which endovascular repair group was better than the open operation group. However，endovascular repair could not improve the postoperative outcomes of paraplegia〔OR=1.30，95% CI （0.82-2.05），P=0.26〕 and acute renal failure 〔OR=0.86，95% CI （0.41-1.80），P=0.69〕.
Conclusion 　Endovascular repair for treatment acute Stanford type B aortic dissection is preferred method.

Citation： ZHANG Kerui,LI Xinxi,WANG Yang,LUO Jun,XIN Hai,WANG Ke,TIAN Ye,BAI Chao. Effectiveness and Safety of Endovascular Aortic Repair and Open Operation in Treatment of Acute Stanford Type B Aortic Dissection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(10): 1092-1099. doi: Copy

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2.	Orend KH， Liewald F， Kirchdorfer B， et al. Management of descending aortic dissection[J]. Ann Ital Chir， 1995， 66(6)： 821-824.
3.	Nienaber CA， Eagle KA. Aortic dissection：new frontiers indiagnosis and management：PartⅡ：therapeutic management and follow-up[J]. Circulation， 2003， 108(6)：772-778.
4.	Tefera G， Acher CW， Hoch JR， et al. Effectiveness of intensive medical therapy in type B aortic dissection：a single-center experience[J] . J Vasc Surg， 2007， 45(6)：1114-1118.
5.	Umana JP， Miller DC， Mitchell RS. What is the best treatment for patients with acute type B aortic dissections—medical， surgical，or endovascular stent-grafting[J]. Ann Thorac Strg， 2002， 74(5)：S1840-S1843.
6.	Hiratzka LF， Bakris GL， Beckman JA， et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease：executive summary. A report of the American College of Cardio-logy Foundation/American Heart Association Task Force on PracticeGuidelines， American Association for Thoracic Surgery， AmericanCollege of Radiology， American Stroke Association， Society of Cardiovascular Anesthesiologists， Society for Cardiovascular Angi-ography and Interventions， Society of Interventional Radiology， Society of Thoracic Surgeons， and Society for Vascular Medicine[J]. Catheter Cardiovasc Interv， 2010， 76(2)： E43-E86.
7.	Parodi JC， PalmazJC， Baroned HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms[J]. Ann Vasc Surg， 1991， 5(6)： 491-499.
8.	Dake MD， Kato N， Mitchell RS， et al. Endovascular stent-graft placement for the treatment of acute aortic dissection[J]. N Engl J Med， 1999， 340(20)：1585-1586.
9.	Nienaber CA， Fattori R， Lund G， et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement[J]. N Engl J Med， 1999， 340(20) ：1539-1545.
10.	Tsai TT， Fattori R， Trimarchi S， et al. Long-term survival in patients presenting with type B acute aortic dissection： insights from the International Registry of Acute Aortic Dissection[J]. Circulation， 2006， 114(21) ： 2226-2231.
11.	Fattori R， Tsai TT， Myrmel T， et al. Complicated acute type B dissection：is surgery still the best option? a report from the International Registry of Acute Aortic Dissection[J]. JACC Cardiovasc Interv， 2008， 1(14)：395-402.
12.	Garbade J， Jenniches M， Borger MA， et al. Outcome of patients suffering from acute type B aortic dissection：a retrospective single-center analysis of 135 consecutive patients[J]. Eur J CardiothoracSurg， 2010， 38(3) ：285-292.
13.	Zeeshan A， Woo EY， Bavaria JE， et al. Thoracic endovascular aorticrepair for acute complicated type B aortic dissection： superiority relative to conventional open surgical and medical therapy[J]. J Thorac Cardiovasc Surg， 2010， 140(6) ： S109-S115.
14.	Mastroroberto P， Onorati F， Zofrea S， et al. Outcome of open andendovascular repair in acute type B aortic dissection：a retros pec-tive and observational study[J]. J Cardiothorac Surg， 2010， 5：23.
15.	Sachs T， Pomposelli F， Hagberg R， et al. Open and endovascularrepair of type B aortic dissection in the Nationwide Inpatient Sample[J]. J Vasc Surg， 2010， 52(4) ： 860-866.
16.	Brunt ME， Egorova NN， Moskowitz AJ. Propensity score-matchedanalysis of open surgical and endovascular repair for type B aortic dissection[J]. Int J Vasc Med， 2011， 2011： 364046.
17.	Murashita T， Ogino H， Matsuda H， et al. Clinical outcome of emergency surgery for complicated acute type B aortic dissection[J]. Circ J 2012， 76(3)： 650-654.
18.	Tsai TT， Trimarchi S， Nienaber CA. Acute aortic dissection：perspectivies from the International Registry of Acute Aortic Dissection (IRAD)[J]. Eur J Vasc Endovasc Surg， 2009， 37(2)：149-159.
19.	Schoder M， Czermy M， Cejna M， et al. Endovascular repair of acute type B aortic dissection：Long-term follow-up of true and false lumen diameter changes[J]. Ann Thorac Surg， 2007， 83(3) ：1059-1066.
20.	Eggebrecht H， Nienaber CA， Neuhauser M， et al. Endovascular stent-graft placement in aortic dissection： a meta-analysis.[J]. Eur Heart J， 2006， 27(4) ：489-498.
21.	Mukherjee D， Evangelista A， Nienaber CA， et al. Implications of periaortic hematoma in patients with acute aortic dissection (from the international registry of acute aortic dissection)[J]. Am J Cardiol， 2005， 96(12) ： 1734-1738.
22.	Di Luozzo G， Geisbüsch S， Lin HM， et al. Open repair of desc-ending and thoracoabdominal aortic aneurysms and dissections in patients aged younger than 60 years： superior to endovascular repair?[J]. Ann Thorac Surg， 2013， 95(1)： 12-19.
23.	Rerkasem K， Rothwell PM. Meta-analysis of small randomized controlled trials in surgery may be unreliable[J]. Br J Surg， 2010， 97(4) ：466-469.

1. Erbel R， Alfonso F， Boileau C， et al. Diagnosis and management of aortic dissection[J]. Eur Heart J， 2001， 22(18)：1642-1681.
2. Orend KH， Liewald F， Kirchdorfer B， et al. Management of descending aortic dissection[J]. Ann Ital Chir， 1995， 66(6)： 821-824.
3. Nienaber CA， Eagle KA. Aortic dissection：new frontiers indiagnosis and management：PartⅡ：therapeutic management and follow-up[J]. Circulation， 2003， 108(6)：772-778.
4. Tefera G， Acher CW， Hoch JR， et al. Effectiveness of intensive medical therapy in type B aortic dissection：a single-center experience[J] . J Vasc Surg， 2007， 45(6)：1114-1118.
5. Umana JP， Miller DC， Mitchell RS. What is the best treatment for patients with acute type B aortic dissections—medical， surgical，or endovascular stent-grafting[J]. Ann Thorac Strg， 2002， 74(5)：S1840-S1843.
6. Hiratzka LF， Bakris GL， Beckman JA， et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease：executive summary. A report of the American College of Cardio-logy Foundation/American Heart Association Task Force on PracticeGuidelines， American Association for Thoracic Surgery， AmericanCollege of Radiology， American Stroke Association， Society of Cardiovascular Anesthesiologists， Society for Cardiovascular Angi-ography and Interventions， Society of Interventional Radiology， Society of Thoracic Surgeons， and Society for Vascular Medicine[J]. Catheter Cardiovasc Interv， 2010， 76(2)： E43-E86.
7. Parodi JC， PalmazJC， Baroned HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms[J]. Ann Vasc Surg， 1991， 5(6)： 491-499.
8. Dake MD， Kato N， Mitchell RS， et al. Endovascular stent-graft placement for the treatment of acute aortic dissection[J]. N Engl J Med， 1999， 340(20)：1585-1586.
9. Nienaber CA， Fattori R， Lund G， et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement[J]. N Engl J Med， 1999， 340(20) ：1539-1545.
10. Tsai TT， Fattori R， Trimarchi S， et al. Long-term survival in patients presenting with type B acute aortic dissection： insights from the International Registry of Acute Aortic Dissection[J]. Circulation， 2006， 114(21) ： 2226-2231.
11. Fattori R， Tsai TT， Myrmel T， et al. Complicated acute type B dissection：is surgery still the best option? a report from the International Registry of Acute Aortic Dissection[J]. JACC Cardiovasc Interv， 2008， 1(14)：395-402.
12. Garbade J， Jenniches M， Borger MA， et al. Outcome of patients suffering from acute type B aortic dissection：a retrospective single-center analysis of 135 consecutive patients[J]. Eur J CardiothoracSurg， 2010， 38(3) ：285-292.
13. Zeeshan A， Woo EY， Bavaria JE， et al. Thoracic endovascular aorticrepair for acute complicated type B aortic dissection： superiority relative to conventional open surgical and medical therapy[J]. J Thorac Cardiovasc Surg， 2010， 140(6) ： S109-S115.
14. Mastroroberto P， Onorati F， Zofrea S， et al. Outcome of open andendovascular repair in acute type B aortic dissection：a retros pec-tive and observational study[J]. J Cardiothorac Surg， 2010， 5：23.
15. Sachs T， Pomposelli F， Hagberg R， et al. Open and endovascularrepair of type B aortic dissection in the Nationwide Inpatient Sample[J]. J Vasc Surg， 2010， 52(4) ： 860-866.
16. Brunt ME， Egorova NN， Moskowitz AJ. Propensity score-matchedanalysis of open surgical and endovascular repair for type B aortic dissection[J]. Int J Vasc Med， 2011， 2011： 364046.
17. Murashita T， Ogino H， Matsuda H， et al. Clinical outcome of emergency surgery for complicated acute type B aortic dissection[J]. Circ J 2012， 76(3)： 650-654.
18. Tsai TT， Trimarchi S， Nienaber CA. Acute aortic dissection：perspectivies from the International Registry of Acute Aortic Dissection (IRAD)[J]. Eur J Vasc Endovasc Surg， 2009， 37(2)：149-159.
19. Schoder M， Czermy M， Cejna M， et al. Endovascular repair of acute type B aortic dissection：Long-term follow-up of true and false lumen diameter changes[J]. Ann Thorac Surg， 2007， 83(3) ：1059-1066.
20. Eggebrecht H， Nienaber CA， Neuhauser M， et al. Endovascular stent-graft placement in aortic dissection： a meta-analysis.[J]. Eur Heart J， 2006， 27(4) ：489-498.
21. Mukherjee D， Evangelista A， Nienaber CA， et al. Implications of periaortic hematoma in patients with acute aortic dissection (from the international registry of acute aortic dissection)[J]. Am J Cardiol， 2005， 96(12) ： 1734-1738.
22. Di Luozzo G， Geisbüsch S， Lin HM， et al. Open repair of desc-ending and thoracoabdominal aortic aneurysms and dissections in patients aged younger than 60 years： superior to endovascular repair?[J]. Ann Thorac Surg， 2013， 95(1)： 12-19.
23. Rerkasem K， Rothwell PM. Meta-analysis of small randomized controlled trials in surgery may be unreliable[J]. Br J Surg， 2010， 97(4) ：466-469.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effectiveness and Safety of Endovascular Aortic Repair and Open Operation in Treatment of Acute Stanford Type B Aortic Dissection

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