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Abstract：
OBJECTIVE: Up to 10% of acute type A aortic dissection (TAAD) patients are deemed unfit for open surgical repair, exposing these patients to high mortality rates. In recent years, thoracic endovascular aortic repair has proven to be a promising alternative treatment modality in specific cases. This study presents a comprehensive overview of the current state of catheter-based interventions in the setting of primary TAAD.
METHODS: A literature search was conducted, using MEDLINE and PubMed databases according to PRISMA guidelines, updated until January 2020. Articles were selected if they reported on the endovascular repair of DeBakey Type I and II aortic dissections. The exclusion criteria were retrograde type A dissection, hybrid procedures, and combined outcome reporting of mixed aortic pathologies (e.g., pseudoaneurysm and intramural hematoma).
RESULTS: A total of 31 articles, out of which 19 were case reports and 12 case series, describing a total of 92 patients, were included. The median follow-up was 6 months for case reports and the average follow-up was 14 months for case series. Overall technical success was 95.6% and 30-day mortality of 9%. Stroke and early endoleak rates were 6% and 18%, respectively. Reintervention was required in 14 patients (15%).
CONCLUSIONS: This review not only demonstrates that endovascular repair in the setting of isolated TAAD is feasible with acceptable outcomes at short-term follow-up, but also underlines a lack of mid-late outcomes and reporting consistency. Studies with longer follow-up and careful consideration of patient selection are required before endovascular interventions can be widely introduced.
METHODS: A literature search was conducted, using MEDLINE and PubMed databases according to PRISMA guidelines, updated until January 2020. Articles were selected if they reported on the endovascular repair of DeBakey Type I and II aortic dissections. The exclusion criteria were retrograde type A dissection, hybrid procedures, and combined outcome reporting of mixed aortic pathologies (e.g., pseudoaneurysm and intramural hematoma).
RESULTS: A total of 31 articles, out of which 19 were case reports and 12 case series, describing a total of 92 patients, were included. The median follow-up was 6 months for case reports and the average follow-up was 14 months for case series. Overall technical success was 95.6% and 30-day mortality of 9%. Stroke and early endoleak rates were 6% and 18%, respectively. Reintervention was required in 14 patients (15%).
CONCLUSIONS: This review not only demonstrates that endovascular repair in the setting of isolated TAAD is feasible with acceptable outcomes at short-term follow-up, but also underlines a lack of mid-late outcomes and reporting consistency. Studies with longer follow-up and careful consideration of patient selection are required before endovascular interventions can be widely introduced.
摘要：
目的：多达10％的急性A型主动脉夹层（TAAD）患者被认为不适合进行开放手术修复，使这些患者面临高死亡率。近年来,在特定病例中，胸主动脉腔内修复术已被证明是一种有前途的替代治疗方式。本研究全面概述了主要TAAD设置中基于导管的干预措施的当前状态。
方法：进行了文献检索，根据PRISMA指南使用MEDLINE和PubMed数据库，更新至2020年1月如果文章报道了DeBakeyI型和II型主动脉夹层的血管内修复，则选择这些文章。排除标准为逆行A型夹层，混合程序，和混合主动脉病变的联合结局报告(例如，假性动脉瘤和壁内血肿）。
结果：共31篇，其中19例是病例报告，12例是病例系列，描述了总共92名患者，包括在内。病例报告的中位随访时间为6个月，病例系列的平均随访时间为14个月。总体技术成功率为95.6%，30天死亡率为9%。卒中和早期内漏发生率分别为6%和18%，分别。14例患者（15%）需要再次干预。
结论：这篇综述不仅表明在孤立的TAAD环境中进行血管内修复是可行的，短期随访结果可接受。但也强调了中后期结果和报告一致性的缺乏。在广泛采用血管内介入治疗之前，需要进行更长的随访和仔细考虑患者选择的研究。
方法：进行了文献检索，根据PRISMA指南使用MEDLINE和PubMed数据库，更新至2020年1月如果文章报道了DeBakeyI型和II型主动脉夹层的血管内修复，则选择这些文章。排除标准为逆行A型夹层，混合程序，和混合主动脉病变的联合结局报告(例如，假性动脉瘤和壁内血肿）。
结果：共31篇，其中19例是病例报告，12例是病例系列，描述了总共92名患者，包括在内。病例报告的中位随访时间为6个月，病例系列的平均随访时间为14个月。总体技术成功率为95.6%，30天死亡率为9%。卒中和早期内漏发生率分别为6%和18%，分别。14例患者（15%）需要再次干预。
结论：这篇综述不仅表明在孤立的TAAD环境中进行血管内修复是可行的，短期随访结果可接受。但也强调了中后期结果和报告一致性的缺乏。在广泛采用血管内介入治疗之前，需要进行更长的随访和仔细考虑患者选择的研究。
