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  • Olsson, Karl Wilhelm,1985-Uppsala University,Uppsala universitet,Kärlkirurgi (author)

Outcomes after endovascular aortic intervention in patients with connective tissue disease

  • Article/chapterEnglish2023

Publisher, publication year, extent ...

  • American Medical Association (AMA),2023
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:umu-212989
  • https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-212989URI
  • https://doi.org/10.1001/jamasurg.2023.2128DOI
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-514612URI
  • https://lup.lub.lu.se/record/83690b70-4676-4445-979c-fe6bc8a6dcc0URI

Supplementary language notes

  • Language:English
  • Summary in:English

Part of subdatabase

Classification

  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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.

Subject headings and genre

Added entries (persons, corporate bodies, meetings, titles ...)

  • Mani, Kevin,1975-Uppsala University,Uppsala universitet,Kärlkirurgi(Swepub:uu)kevma940 (author)
  • Burdess, AnneUppsala University,Uppsala universitet,Kärlkirurgi(Swepub:uu)annbu943 (author)
  • Patterson, SuzannahDivision of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, United States (author)
  • Scali, Salvatore T.Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, United States (author)
  • Kölbel, TiloDepartment of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany(Swepub:lu)kirm-tko (author)
  • Panuccio, GiuseppeDepartment of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany (author)
  • Eleshra, AhmedDepartment of Vascular Medicine, German Aortic Center, University Heart Center, Hamburg, Germany (author)
  • Bertoglio, LucaDivision of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy (author)
  • Ardita, VincenzoDivision of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy (author)
  • Melissano, GermanoDivision of Vascular Surgery, Vita Salute San Raffaele University, San Raffaele Hospital, Milano, Italy (author)
  • Acharya, AmishImperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom,Johns Hopkins Hospital (author)
  • Bicknell, ColinImperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom (author)
  • Riga, CeliaImperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom (author)
  • Gibbs, RichardImperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom (author)
  • Jenkins, MichaelImperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom (author)
  • Bakthavatsalam, ArvindDivision of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, United States (author)
  • Sweet, Matthew P.Division of Vascular Surgery, Department of Surgery, University of Washington Medical Center, Seattle, United States (author)
  • Kasprzak, Piotr M.Department of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany,University Hospital Regensburg (author)
  • Pfister, KarinDepartment of Vascular and Endovascular Surgery, University Medical Centre Regensburg, Regensburg, Germany,University Hospital Regensburg (author)
  • Oikonomou, KyriakosDepartment 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 (author)
  • Heloise, TesselyDepartment of Vascular Surgery, Centre Hospitalier Universitaire de Lille, Lille, France,Lille University Hospital (author)
  • Sobocinski, JonathanDepartment of Vascular Surgery, Centre Hospitalier Universitaire de Lille, Lille, France,Lille University Hospital (author)
  • Butt, TalhaLund University,Lunds universitet,Vaskulära sjukdomar - kliniska studier,Forskargrupper vid Lunds universitet,Vascular Diseases - Clinical Research,Lund University Research Groups,Skåne University Hospital(Swepub:lu)med-tbt (author)
  • Dias, NunoLund University,Lunds universitet,Vaskulära sjukdomar - kliniska studier,Forskargrupper vid Lunds universitet,Vascular Diseases - Clinical Research,Lund University Research Groups,Skåne University Hospital(Swepub:lu)ront-ndi (author)
  • Tang, ChingDepartment of Surgery, Queen Mary Hospital, Hong Kong, China (author)
  • Cheng, Stephen W. K.Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong, China (author)
  • Vandenhaute, SarahDepartment of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium (author)
  • Van Herzeele, IsabelleDepartment of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium (author)
  • Sorber, Rebecca A.Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, MD, Baltimore, Liberia (author)
  • Black, James H.Department of Vascular Surgery and Endovascular Therapy, Johns Hopkins Hospital, MD, Baltimore, Liberia (author)
  • Tenorio, Emanuel R.Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, United States (author)
  • Oderich, Gustavo S.Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, United States (author)
  • Vincent, ZoëDepartment of Vascular Surgery, Waikato Hospital, University of Auckland, Hamilton, New Zealand (author)
  • Khashram, ManarDepartment of Vascular Surgery, Waikato Hospital, University of Auckland, Hamilton, New Zealand (author)
  • Eagleton, Matthew J.Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, MA, Boston, United States (author)
  • Pedersen, Steen FjordDivision of Vascular Surgery, Department of Cardiovascular Sugery, Aarhus University Hospital, Aarhus, Denmark (author)
  • Budtz-Lilly, JacobDivision of Vascular Surgery, Department of Cardiovascular Sugery, Aarhus University Hospital, Aarhus, Denmark (author)
  • Lomazzi, ChiaraFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Maggiore Hospital Policlinico (author)
  • Bissacco, DanieleFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Maggiore Hospital Policlinico (author)
  • Trimarchi, SantiFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Milan, Italy,Maggiore Hospital Policlinico (author)
  • Huerta, AbigailVascular Surgery Department, CardioVascular Institute, Hospital Clinic, Barcelona, Spain,Hospital Clínic of Barcelona (author)
  • Riambau, VincentVascular Surgery Department, CardioVascular Institute, Hospital Clinic, Barcelona, Spain,Hospital Clínic of Barcelona (author)
  • Wanhainen, AndersUppsala University,Umeå University,Uppsala universitet,Umeå universitet,Kirurgi,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden,Kärlkirurgi(Swepub:uu)anwan103 (author)
  • Uppsala universitetKärlkirurgi (creator_code:org_t)

Related titles

  • In:JAMA Surgery: American Medical Association (AMA)158:8, s. 832-8392168-62542168-6262

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