Systematic review of outcomes of combined proximal stent grafting with distal bare stenting for management of aortic dissection

Objective: Available data on outcomes of combined proximal stent grafting with distal bare stenting for management of aortic dissection are limited. This is a systematic review of outcomes of this approach. Methods: Studies involving combined proximal stent grafting with distal bare stenting for management of aortic dissection were systematically searched and reviewed. Results: A total of 4 studies were included, with 108 patients treated for acute (n = 54) and chronic (n = 54) aortic dissection. Technical success rate was 95.3% (range, 84-100). The 30-day mortality was 2.7% (range, 0%-5%). Morbidity rate within 30 days was 51.8% (range, 0%-65%) and included stroke (2.7%), paraplegia (2.7%), retrograde dissection (1.8%), renal failure (14.8%), severe cardiopulmonary complications (5.5%), and bowel ischemia (0.9%). Incidence of type I endoleak was 9.2%(10/108). During follow-up, 5 patient deaths (4.6%) were related to aortic rupture or aortic repair. Reintervention rate was from 12.9%. Two cases of delayed retrograde type A dissection (1.9%) and 1 case of aortobronchial fistula (0.9%) were reported. Most common delayed complication was thoracic stent-graft migration (4.7%). Device failure rate was 9.2%. Favorable aortic remodeling was observed: studies reporting midterm follow-up of the true lumen demonstrated high rates of false-lumen regression and true-lumen expansion. At 12 months, complete false-lumen thrombosis was observed at the thoracic level in 70.4% and at the abdominal level in 13.5%. Conclusions: Combined proximal stent grafting with distal bare stenting for management of aortic dissection appears to be a reasonable approach for type B aortic dissection, clearly improved true-lumen perfusion and diameter although failing to suppress false-lumen patency completely. Contemporary information on this approach is mainly provided by small series with a wide range of results.