Evaluation des endoprothèses dans le traitement des anévrismes et des dissections de l'aorte thoracique - Stent-grafts in the treatment of thoracic aortic aneurysm and dissection - Abstract

Has

Description

Posted on Feb 01 2006 A summary statement in English will be available in due course. Posted on Feb 01 2006

Sujets

• Économie de la santé

Informations

• Publié par: haute-autorite-sante-maladies-vasculaires
• Publié le: 01 février 2006
• Nombre de lectures: 13
• Licence : En savoir +
  Paternité, pas d'utilisation commerciale, partage des conditions initiales à l'identique
• Langue: Français

Extrait

Stent-grafts in the treatment of thoracic aortic aneurysm and dissection   HAS, Saint-Denis La Plaine, France Authors: Emmanuel Corbillon MD, Celia Primus MSc, Anne-Isabelle Poullié MSc   Aim To determine the efficacy and safety of stent-grafts in the treatment of thoracic aortic aneurysm and dissection, and the economic impact of their use.    Results and conclusions •Efficacy.Endovascular stent-grafting (ESG) repair for lesions of the thoracic aorta, including aneurysm, dissection and rupture of the aortic isthmus, is probably beneficial in terms of operative mortality and severe morbidity, provided that there is a rigorous medium-term assessment (incidence of paraplegia: 2.1% (range 0-7%) for ESGversus  5% (3-15%) for surgery) and provided that anatomical factors are favourable. In particular, a proximal neck length of at least 2 cm is needed to insert the stent-graft. •Cost.No French cost studies were found. In the single study (Netherlands) comparing the costs of treating aneurysms of the descending thoracic aorta by ESG repair and open surgery, the mean hospital costs per patient for ESG repair were 60% lower than  those for open surgery despite the high cost of stent-grafts. This was mainly because of

the shorter time spent in the intensive care unit and the shorter hospital stay.   - Possible indications for ESG in thoracic aortic aneurysm and dissection are those for surgery. ESG would be particularly appropriate in patients with multiple trauma to the thoracic aorta whose concomitant lesions contraindicate a definitive surgical procedure. - Treatment can only be carried out in centres with expertise in both endovascular and surgical procedures, and with adequate technical facilities. - Patients should be informed of the advantages and drawbacks of both methods. - Treatment with ESG may be carried out in either public or private centres, subject to prior multidisciplinary discussion, particularly concerning the risk of converting to open surgery and the possible need for cardiopulmonary bypass. - Patients should be monitored annually by CT scan or MRI + plain radiograph as long-  term results are uncertain (possible stent-graft deterioration, onset of aortic disease). They should be told of the need for monitoring and for possible further treatment.      Methods   The report was produced using a recognised technology assessment method combining a critical literature review and expert opinion. Several databases (Medline, Embase and Pascal) were searched (Jan. 1995 – Dec. 2004), together with useful websites, the grey literature and major articles published in 2005. A draft report was produced and submitted to a working group of 12 members nominated by relevant learned societies. The report was amended and then submitted to a multidisciplinary group of 12 peer reviewers for comment.   Looking ahead   An accurate prospective registry of all thoracic aorta procedures (endovascular, surgical or combined (both extra-anatomic bypass and thoracic ESG both surgical and ESG), should be set up. It should be compulsory for all practitioners and stent-graft manufacturers. It should include information on patient monitoring in order to (i) select patients who could be treated with ESG, (ii) assess the feasibility of a randomised controlled study comparing ESG and surgery, (iii) assess the medium-term outcome of the devices, and (iv) obtain a better understanding of health economics aspects.