Contemporary strategies for repair of complex thoracoabdominal aortic aneurysms: real-world experiences and multilayer stents as an alternative

Abstract

Thoracoabdominal aortic aneurysms (TAAA) present special challenges for repair due to their extent, their distinctive pathology, and the fact that they typically cross the ostia of one or more visceral branch vessels. Historically, the established treatment for TAAA was open surgical repair, with the first procedure reported in 1955. Endovascular repair of TAAA with fenestrated and/ or branched endografts, has been studied since the beginning of the current century as a means of mechanical aneurysm exclusion. More recently, flow modulator stents have been employed with the aim at reducing shear stress on aortic aneurysmal wall. In this review we present technical and main results of these techniques, based on literature review and personal experience.

Aortic arch aneurysm. Treatment with multilayer flow modulator plus coil embolizati-on

“…Cabe destacar que la repermeabilización del saco posiblemente haya tenido una estrecha vinculación con el tratamiento con anticoagulantes. Este punto se describe en la literatura (10). Frente a este inconveniente optamos por embolizar a través de las celdas del stent con un microcatéter, maniobra que no fue extremadamente compleja.…”

Aortic Remodeling After Total Endovascular Aortic Repair With Multilayer Stents: Computational Fluid Dynamics Analysis of Aortic Remodeling Over 3 Years of Follow-up

“…11 A more aggressive open surgical approach is therefore encouraged by some authors. 5 Despite technical advances, open repair has a mortality rate of 14% to 31%, with poor clinical results. 11 Endovascular therapies are emerging as the method of choice for TBAD treatment.…”

“…Multilayer aortic stents have been reported as a safe alternative for the endovascular treatment of thoracoabdominal aneurysms in high-risk patients. 5,6 Rodriguez et al 7 were the first to demonstrate the feasibility of implanting multilayer stents in the ascending aorta. Recently, encouraging early results were presented for endovascular treatment of TBAD with multilayer stents partially 8 or totally 9 covering the aortic arch.…”

Challenges and experience of setting up an aortic service

“…However, surgical and endovascular options can be associated with different results in various settings that need to be tailored to the aortic pathology/anatomy, the experience of operators, and the facilities of the aortic center. 23 EVAR has been an emerging technique with good early outcomes for thoracoabdominal aortic pathologies. [24][25][26][27][28] On the other hand, the late outcomes of EVAR have been inconsistent in large trials (EVAR and OVER trials) for patients with abdominal AA.…”