Endovascular Approaches to Acute Aortic Type A Dissection: A CT-Based Feasibility Study

Sobocinski, Jonathan; O’Brien, Noel; Maurel, Blandine; Bartoli, Michel; Gouëffic, Yann; Sassard, Thomas; Midulla, Marco; Koussa, Mohamad; Vincentelli, André; Haulon, Stéphan

doi:10.1016/j.ejvs.2011.04.037

Cited by 91 publications

(55 citation statements)

References 22 publications

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“…From an anatomical perspective, 30% to 50% patients with type A aortic dissection are amenable to TEVAR. 20,21 Thus, in the future more patients may be considered suitable for TEVAR with life-long follow-up. The ultimate goal is a fully catheter-based approach to repair the ascending aorta that minimizes procedural risk and initiates healing (as documented in type B dissections in which interventional entry closure is associated with thrombosis of the false lumen and favorable aortic remodeling).…”

Section: See Editorial Commentary Page S12mentioning

confidence: 99%

Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application?

Nienaber

Sakalihasan

Clough

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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Section: See Editorial Commentary Page S12mentioning

confidence: 99%

Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application?

Nienaber

Sakalihasan

Clough

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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“…In 2000 Dorros et al reported the first case of type A aortic dissection managed with en endovascular technique through a transseptal approach [3], while Metcalfe et al described a case of endovascular repair of an acute type A dissection using an endograft designed for the ascending aorta introduced through the common femoral artery [5].…”

Section: Discussionmentioning

confidence: 99%

Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm

Bejjani¹

2018

IJCTS

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Classic open ascending aortic replacement is an effective treatment for Stanford type A aortic dissection However it is associated with a mortality ranging between 15 to 60%. This incidence is even higher in recurrent cases. In these patients, hybrid procedures which combine thoracic endovascular aortic repair (TEVAR) with aortic arch vessel bypasses are successfully adopted. This paper reports a successful hybrid management of aortic arch pseudoaneurysm in a 66 year old female patient known to be hypertensive, diabetic,smoker dyslipidemic on dialysis and who underwent one year previously a surgical ascending aortic repair. Aortic arch vessel bypasses-necessary in this case-were facilitated by the presence of an aberrant right subclavian artery known as Arteria Lusoria-This variant, a rare embryologic anomaly of the aortic arch vessels, described by Hunauld in 1735, was used as an inflow artery to the right common carotid allowing the surgeons to avoid a left to right common carotid artery bypass known to be associated with many complications. Although the hybrid management seems a feasible and safe option especially in high risk patients not eligible for open surgical repair, furher clinical studies and development of new devices dedicated to treat ascending aortic diseases are fundamental to improve outcomes.

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“…They report that, based on current device designs 32e50% of patients currently undergoing open repair for TAAD could potentially be candidates for endovascular repair. 15,16 [ Table 1]…”

Section: Morphological Suitabilitymentioning

confidence: 99%

Progress in Endovascular Management of Type A Dissection

Nordon

Hinchliffe

Morgan

et al. 2012

European Journal of Vascular and Endovascular Surgery

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Proximal acute aortic dissection [type A] remains a disease with a poor prognosis. High peri-operative open surgical mortality [up to 30%] and a significant turn-down rate [up to 40%] substantiate the bleak prospects for patients with this disease. Thoracic endovascular stent grafting has revolutionized the treatment of distal [type B] acute aortic dissection. Endovascular surgeons are now looking to improve the treatment of type A dissection by offering endovascular techniques to supplement conventional surgical therapy. Less invasive endovascular therapy, obviates the need for sternotomy and cardiopulmonary bypass, may reduce perioperative morbidity and offers a solution for those patients declined conventional intervention due to co-morbidity or severe complications of the disease. Thoracic stent grafting in the ascending aorta presents specific challenges due to proximity to the aortic valve, navigation over the steep aortic arch and pulsatile aortic movement. Endovascular surgeons have treated type A dissection off-license using aortic cuffs and stents designed for infra-renal aortic surgery. Now grafts specifically designed for treating type A dissection are being developed and deployed under trial [compassionate license] in patients deemed unfit for open surgery. This paper explores how endovascular solutions may fit into the future care of patients with acute type A dissection.

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Endovascular Approaches to Acute Aortic Type A Dissection: A CT-Based Feasibility Study

Abstract: Open repair of acute type A dissection is and remains the 'gold standard' of care. Our study demonstrates that approximately half the patients undergoing an open repair could potentially benefit from an endovascular repair. This new treatment option has not been evaluated to date.

Cited by 91 publications

References 22 publications

Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application?

Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application?

Arteria Lusoria Facilitates Hybrid Management of Aortic Arch Pseudoaneurysm

Progress in Endovascular Management of Type A Dissection

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