000			04664nam a22007937a 4500
008			210310s20212021 xxu||||| |||| 00| 0 eng d
022			_a0741-5214
024			_a10.1016/j.jvs.2021.01.054 [doi]
024			_aS0741-5214(21)00198-1 [pii]
040			_aOvid MEDLINE(R)
099			_a33592292
245			_aSystematic review and meta-analysis of endovascular interventions for Stanford type A aortic dissection. [Review]
251			_aJournal of Vascular Surgery. 74(5):1721-1731.e4, 2021 11.
252			_aJ Vasc Surg. 74(5):1721-1731.e4, 2021 11.
252			_zJ Vasc Surg. 2021 Feb 13
253			_aJournal of vascular surgery
260			_c2021
260			_fFY2021
265			_saheadofprint
265			_sppublish
266			_d2021-03-10
268			_aJournal of Vascular Surgery. 2021 Feb 13
269			_fFY2021
501			_aAvailable online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
520			_aCONCLUSION: The technique for endovascular repair of type A aortic dissection is feasible and reproducible. Meta-analysis of short-term outcomes demonstrate an acceptable safety profile in inoperable patients who otherwise would have an extremely poor prognosis. Data from clinical trials are required before the technique can be introduced into routine clinical practice. Copyright (c) 2021. Published by Elsevier Inc.
520			_aMETHODS: The systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Online literature databases searches were current through April 2020. Demographic and procedural characteristics of individual studies were tabulated. Data on technical success, short-term mortality, stroke and reintervention were extracted and underwent meta-analysis using a random-effects model.
520			_aOBJECTIVE: The standard surgical approach to Stanford type A aortic dissection is open repair. Up to one-in-four patients are declined surgery due to prohibitive risk. Patients that are managed nonoperatively have an unacceptably high mortality. Endovascular repair of the ascending aorta is emerging as an alternative for a select group of patients. The reported rates of technical success, mortality, stroke and reintervention are variable. The objective of this study is to systematically report on outcomes for acute type A dissections repaired with an endovascular approach.
520			_aRESULTS: Fourteen studies with 80 aortic dissections (55 acute, 25 subacute) were included in the final analysis. There was wide variation in technique and device design across studies. Outcomes rates were estimated at 17% (95% CI: 10-26%) for mortality, 15% (95% CI: 8-23%) for technical failure, 11% (95% CI: 6-19%) for stroke and 18% (95% CI: 9-31%) for reinterventions. The mean Downs and Black quality assessment score was 13.9 (SD +/-3.2).
546			_aEnglish
650			_a*Aneurysm, Dissecting/su [Surgery]
650			_a*Aortic Aneurysm/su [Surgery]
650			_a*Blood Vessel Prosthesis Implantation
650			_a*Endovascular Procedures
650			_aAdult
650			_aAged
650			_aAged, 80 and over
650			_aAneurysm, Dissecting/dg [Diagnostic Imaging]
650			_aAneurysm, Dissecting/mo [Mortality]
650			_aAortic Aneurysm/dg [Diagnostic Imaging]
650			_aAortic Aneurysm/mo [Mortality]
650			_aBlood Vessel Prosthesis Implantation/ae [Adverse Effects]
650			_aBlood Vessel Prosthesis Implantation/mo [Mortality]
650			_aClinical Decision-Making
650			_aEndovascular Procedures/ae [Adverse Effects]
650			_aEndovascular Procedures/mo [Mortality]
650			_aFemale
650			_aHumans
650			_aMale
650			_aMiddle Aged
650			_aPatient Safety
650			_aRisk Assessment
650			_aRisk Factors
650			_aTreatment Outcome
651			_aMedStar Heart & Vascular Institute
651			_aMedStar Washington Hospital Center
656			_aSurgery/Vascular Surgery
657			_aJournal Article
657			_aReview
700			_aAbramowitz, Steven D
700			_aDe Freitas, Simon Peter
700			_aFatima, Javairiah
700			_aKiguchi, Misaki M
700			_aRossi, Matthew John
700			_aVallabhaneni, Raghuveer
700			_aWoo, Edward Y
790			_aAbramowitz SD, De Freitas S, Fatima J, Kiguchi MM, Rossi MJ, Vallabhaneni R, Walsh SR, Woo EY
856			_uhttps://dx.doi.org/10.1016/j.jvs.2021.01.054 _zhttps://dx.doi.org/10.1016/j.jvs.2021.01.054
942			_cART _dArticle
999			_c6222 _d6222