REVIEW  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2024 April;65(2):139-46

DOI: 10.23736/S0021-9509.23.12648-6

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Long-term outcomes of thoracic endovascular aortic repair for the treatment of descending thoracic aortic aneurysms: a systematic review and meta-analysis

Georgios I. KARAOLANIS ¹ ✉, Efstratios GEORGAKARAKOS ², Agathi KARAKOSTA ³, Georgios K. GLANTZOUNIS ⁴, Konstantinos G. MOULAKAKIS ⁵, Bernhard DORWEILER ⁶, Spyridon N. MYLONAS ⁷

¹ Vascular Unit, Department of Surgery, University Hospital of Ioannina and School of Medicine, Ioannina, Greece; ² Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece; ³ Department of Anesthesia and Postoperative Intensive Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece; ⁴ Department of Surgery, School of Health Sciences, University Hospital of Ioannina and Faculty of Medicine, University of Ioannina, Ioannina, Greece; ⁵ Department of Vascular Surgery, University of Patras, Patra, Greece; ⁶ Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany; ⁷ Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany

INTRODUCTION: We undertook a systematic review of the currently published literature on TEVAR for DTAAs and we combined the eligible studies into a meta-analysis with the intention of evaluating the efficacy and the long-term durability of this treatment option.
EVIDENCE ACQUISITION: A systematic search of the literature from January 2015 up to December 2022 was performed according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. For events during follow-up we calculated the incidence rates (IRs) with 95% confidence intervals (95% CIs) per 100 patient-years (p-ys) as the number of patients with outcome events occurring during the specific time period divided by the total number of p-ys.
EVIDENCE SYNTHESIS: A total of 4127 study titles were identified by the initial search strategy, of which 12 were considered eligible for inclusion in the meta-analysis. A Total of 1976 patients (62% male) were identified among the eligible studies. One-year survival was 90.1% (95% CI 86.3% to 93.0%), 3-year survival was estimated at 80.5% (95% CI 69.2% to 88.4%) and the 5-year survival was estimated at 73.2% (95%CI 64.3% to 80.5%) with significant heterogeneity among studies regarding these outcomes. Regarding freedom from reintervention analysis for 1 year and 5 years was 96.5% (95% CI 94.5% to 97.8%) and 85.4% (95% CI 56.7% to 96.3%) respectively. The pooled late complications IR per 100 p-ys was 55.0 (95% CI 39.1 to 70.9), whereas the pooled IR for late reinterventions per 100 p-ys was 21.2 (95% CI 26.0 to 87.5). Late type I endoleak was reported with a pooled IR of 26.7 per 100 p-ys (95% CI 19.8 to 33.6) and late type III endoleak with a pooled IR of 7.6 per 100 p-ys (95% CI 5.5 to 9.7).
CONCLUSIONS: TEVAR presents a safe and feasible solution for the treatment of DTAA with sustained long-term effectivity. Current evidence supports a satisfactory 5-year survival with low rates of reinterventions.

KEY WORDS: Thoracic endovascular aortic repair (TEVAR); Thoracic aortic aneurysm; Aneurysm; Descending aorta; Stent graft; Mortality