Breaking the Rules About Endovascular Aortic Intervention and Connective Tissue Disease

Abstract

Learn the rules like a pro so you can break them like an artist.-Pablo Picasso Rules are rules for a reason. Endovascular repair, considered standard for many patients with aortic diseases, has been eschewed in connective tissue diseases (CTDs). The radial force and attachment modalities needed for endovascular repair would seem logically to initiate tissue injury, degeneration, and complications with later reintervention and conversion. Many patients with CTD require multiple staged or interval aortic operations leading to total aortic replacement. While early technical successes with endovascular solutions in CTD were not surprising, later issues have been problematic. 1 As such, recent guidelines for the treatment of type B aortic dissection state that as a class I recommendation, open repair remains preferable and more durable in CTD, with endovascular repair reserved as a bridge to delayed open repair. 2 New multidisciplinary guidelines allude to the same. 3 Both sets of guidelines ask for more probing data on endovascular aortic repair in CTD.Consequently, the contribution from Olsson and coauthors and the EVICTUS multicontinent, multicenter registry is timely, relevant, and valuable. 4 These experienced centers both demonstrated impressive technical and operative results for 171 patients with CTD after performing complex, extensive endovascular aortic repair and garnered midterm, granular results. This represents the largest CTD cohort to date treated with endovascular repair. The median follow-up time of 4.7 years is critical to our understanding. Some half of pa-Breaking the Rules About Endovascular Aortic Intervention and Connective Tissue Disease Invited Commentary