Evidence map›Paper›PMID 37087065›Full record

ArticleEuropean journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery2023

Outcomes of Complex Endovascular Treatment of Post-Dissection Aneurysms.

Thomas F X O'Donnell, Priya B Patel, Christina L Marcaccio, Kirsten D Dansey, Nicholas J Swerdlow, Vinamr Rastogi, Virendra I Patel, Adam W Beck, Sara L Zettervall, Marc L Schermerhorn

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Article in European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Thomas F X O'DonnellDepartment of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA; Division of Cardiac, Thoracic, and Vascular Surgery, New York-Presbyterian/Columbia University Irving Medical Centre/Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA.
Priya B PatelDivision of General Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Christina L MarcaccioDepartment of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.
Kirsten D DanseyDepartment of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.
Nicholas J SwerdlowDepartment of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.
Vinamr RastogiDepartment of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.
Virendra I PatelDivision of Cardiac, Thoracic, and Vascular Surgery, New York-Presbyterian/Columbia University Irving Medical Centre/Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA.
Adam W BeckDivision of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL, USA.
Sara L ZettervallDivision of Vascular and Endovascular Surgery, University of Washington, Seattle, WA, USA.
Marc L SchermerhornDepartment of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.

Funding

HARVARD-LONGWOOD RESEARCH TRAINING IN VASCULAR SURGERYT32HL007734 · NHLBI · BETH ISRAEL DEACONESS MEDICAL CENTER · PI FERRAN, CHRISTIANE, LOGERFO, FRANK W · 1993 to 2023
$10.5M
Disparities in Detection and Treatment of Abdominal Aortic Aneurysm DiseaseF32HS027285 · AHRQ · BETH ISRAEL DEACONESS MEDICAL CENTER · PI MARCACCIO, CHRISTINA · 2020 to 2021
$154k
AHRQ HHS F32 HS027285NHLBI NIH HHS T32 HL007734
6 · The paper itself

Abstract

objectiveReports of endovascular treatment of chronic post-dissection aneurysms are limited to high volumes centres, posing questions about generalisability.

methodsAll endovascular repairs of intact pararenal and thoraco-abdominal aneurysms in the Vascular Quality Initiative from 2014 to 2021 were studied, and peri-operative and long term outcomes were compared between repairs of degenerative and post-dissection aneurysms. Peri-operative outcomes were compared using mixed effects logistic regression, and long term outcomes using Medicare linkage.

resultsThere were 123 patients who completed treatment for post-dissection aneurysms and 3 635 for degenerative aneurysms, with 36% of post-dissection repairs and 6.7% of degenerative repairs performed in a staged fashion (p < .001). The majority (84%) of post-dissection aneurysms were extensive thoraco-abdominal aneurysms (TAAAs: Crawford Type 1, 2, 3, 5), compared with 22% of degenerative aneurysms (p < .001). Physician modified endografts were the primary repair type for post-dissection (73%), while commercially available fenestrated grafts were the dominant repair for degenerative (48%). The first stage of staged procedures was associated with a 2.8% peri-operative mortality rate, 5.1% spinal cord ischaemia, and 8.9% thoraco-abdominal life altering events (the composite of peri-operative death, stroke, permanent spinal cord ischaemia, and dialysis). Th final stage procedure and fluoroscopy times were similar, but technical success was lower in post-dissection repairs (75% vs. 83%, p = .018), both due to issues with the main endograft or bridging vessels (11% vs. 6.6%, p = .055), and types 1and 3 endoleak at completion (17% vs. 10%, p = .035). In addition, high volume surgeons had two fold higher odds of technical success than their low volume counterparts. Adjusted peri-operative outcomes were similar between pathology types, including when comparisons were restricted to extensive TAAAs. Crude and adjusted three year survival were similar, but three year re-interventions were significantly higher following post-dissection repairs (p < .001).

conclusionComplex endovascular repair of chronic post-dissection aneurysms is feasible but is associated with high rates of re-interventions and non-trivial rates of lack of technical success. More data are needed to evaluate the long term durability of these procedures, and the utility of centralising these complex procedures.

Indexed as

Aortic Aneurysm, AbdominalAortic Aneurysm, ThoracicBlood Vessel Prosthesis ImplantationEndovascular ProceduresSpinal Cord IschemiaAgedBlood Vessel ProsthesisHumansMedicareRisk FactorsTreatment OutcomeUnited StatesAortic aneurysmEndovascular repairFenestrated endovascular aneurysm repairPost-dissection aneurysmThoraco-abdominal aneurysm

Identifiers

PMID37087065
PMCPMC10524097

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.