P-067 - DISTAL STENT GRAFT-INDUCED NEW ENTRY AFTER ENDOVASCULAR REPAIR OF THORACIC AORTIC DISEASE: SYSTEMATIC REVIEW AND META-ANALYSIS.

TOPIC:
Thoraco-abdominal Aortic Disease
AUTHORS:
Odderskov C. (Division of Vascular Surgery, Department of Cardiovascular Surgery, Aalborg University Hospital ~ Aalborg ~ Denmark) , Budtz-Lilly J. (Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital ~ Aarhus ~ Denmark) , D'Oria M. (Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI ~ Trieste ~ Italy) , Lepidi S. (Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI ~ Trieste ~ Italy) , Trimarchi S. (Division of Vascular Surgery Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, University of Milan ~ Milano ~ Italy) , Biassacco D. (Division of Vascular Surgery Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, University of Milan ~ Milano ~ Italy)
Introduction:
Increased awareness of risk factors for distal stent graft-induced new entry (dSINE) is needed as the use and follow-up of endograft treatment for various aortic arch and descending aortic pathologies continues to increase. Focus must be given to both patient characteristics and the underlying pathology, as well as the individual endograft sizing and structural properties.
Methods:
An electronic database search of all English language literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Patient demographics, indications for treatment, in addition to pertinent endograft sizing and characteristics were identified. Pooled proportion rates and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models, while heterogeneity and publication bias were also assessed.
Results:
A total of 38 retrospective studies (population-cohort and case-control studies) were identified with 7044 included patients. There was significant heterogeneity among the patients, pathology treated, devices utilized, and outcomes reported. The pooled proportion of dSINE among patients treated for aortic dissection (AD) was 8.0% (95% CI, 7.0-9.0) and 5.0% (95% CI, 1.0-9.0) for aneurysmal disease. Patient sex was not associated with dSINE; female patient OR = .98 (95% CI, .65-1.48). The pooled OR for chronic AD against acute AD was 1.57 (95% CI, .94-2.63). The pooled OR for AD as opposed to aneurysmal treatment was 1.0 (95% CI, .21-4.7). Excessive distal oversizing OR was 2.11 (95%, CI, 1.34-3.01). Funnel plots revealed publication bias.
Conclusion:
The incidence of dSINE is low but not insignificant following endograft treatment for aortic disease, and patient sex and underlying pathology do not play a predictive role for dSINE. Excessive oversizing, on the other hand, is associated with dSINE, and proper vigilance should be maintained for all patients who undergo this interventional treatment. Further and more harmonized studies are needed in order to better predict and prevent this complication.