Short-Term Curative Effect of Endovascular Stent-Graft Treatment for Aortic Diseases in China: A Systematic Review

Siwen Wang,Shenming Wang,Xiaoxi Li,Chen Yao,Peiliang Lin,Jinsong Wang,Zhibin Li,Guangqi Chang,Junming Yue

doi:10.1371/journal.pone.0071012

Siwen Wang, Shenming Wang + Show 7 more

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https://doi.org/10.1371/journal.pone.0071012

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Abstract

IntroductionWe analyzed the short-term efficacy of endovascular treatment for aortic diseases by summarizing all available published data on endovascular stent-graft treatment for abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA), type A aortic dissection (type A AD) and type B aortic dissection (type B AD) in China.MethodsWe performed a systematic analysis of 935 published series on retrograde endovascular treatment for aortic diseases in China from January 1996 to November 2010. Based on the inclusion criteria, 159 studies, involving a total of 5531 patients, were included.ResultsThere were no significant differences in procedural success among the studies (P>0.05). The rates of overall neurologic complications and stroke were significantly different in all two-group comparisons (P<0.01). The type A AD patients had the highest rates of neurologic complications (both 6.67±0.00%), and the AAA patients had the lowest rates (0.31±0.04% and 0.11±0.02%). Significant differences were noted in the rates of cardiac, renal, pulmonary and visceral complications, which were all higher in the type A AD patients than in the other three groups (P<0.01). The endoleak rate was highest in the TAA patients (19.27±5.74%) and was similar in the type A AD patients (P>0.05). A significant difference was noted between the 30-day mortality rate of the type A AD patients and the AAA or type B AD patients (P<0.05).ConclusionEndovascular stent-graft is a feasible and safe treatment for aortic diseases, with high procedural success and low incidences of post-procedural complications and short-term mortality. Endovascular treatment for AAA and type B AD is more efficient than for type A AD and TAA.

Highlights

We analyzed the short-term efficacy of endovascular treatment for aortic diseases by summarizing all available published data on endovascular stent-graft treatment for abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA), type A aortic dissection and type B aortic dissection in China
No significant differences were identified between the male-to-female ratios of the type A aortic dissection (AD) and type B AD patients (P.0.05), but there were significant differences in the other two-group comparisons (P,0.01)
No significant differences were identified in the incidence of hypertension between the type A AD patients and TAA patients (P.0.05), but significant differences were noted for the other two-group comparisons (P,0.01)

Summary

Introduction

We analyzed the short-term efficacy of endovascular treatment for aortic diseases by summarizing all available published data on endovascular stent-graft treatment for abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA), type A aortic dissection (type A AD) and type B aortic dissection (type B AD) in China. Endovascular stent-graft treatment was developed in the 1990s. In 1991, Parodi et al [2] first reported the application of an endovascular repair technique for the treatment of abdominal aortic aneurysm (AAA). In 1994, Dake et al [3] used transluminal stent-graft placement to treat thoracic aortic aneurysm (TAA). In 1999, Dake et al [4] and Nienaber et al [5] separately reported that endovascular stent-graft placement was successfully used to treat Stanford type B aortic dissection (type B AD). Sueda et al [6] and Mizunoa et al [7] developed stented elephant-trunk transplantation procedures for the endovascular treatment of Stanford type A aortic dissections in 1999 and 2002, respectively (type A AD). In 2002, Kato et al [8]

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