Endovascular management of ascending aortic pathology

Abstract

Stent grafting of the ascending aorta is technically feasible but should be reserved for selected high-risk patients only, preferably in centers where vascular specialists cooperate closely with interventional cardiologists. Cardiac surgery with cardiopulmonary bypass is still the gold standard to treat ascending aortic aneurysms. Stent graft exclusion of more advanced and complex ascending aortic pathology should be performed only in centers with the necessary experience in transvalvular cardiac procedures.

Endovascular stent grafting for ascending aorta repair in high-risk patients

“…Development of devices dedicated to treat ascending aortic pathology is needed to improve outcomes. (J Thorac Cardiovasc Surg 2014;-: [1][2][3][4][5][6][7][8][9][10][11] Video clip is available online.…”

“…Only a small number of studies have described outcomes with this approach. [4][5][6][7][8][9][10][11] Currently there are no commercially available endovascular devices specifically designed to treat the ascending aorta. Compared with TEVAR of the descending thoracic aorta, endovascular therapy for the ascending aorta is challenged by more complex pathology, hemodynamic characteristics, and anatomy.…”

Endovascular repair of the ascending aorta in patients at high risk for open repair

“…Other aortic centers of excellence have also reported small series of endovascular repair of the ascending aorta with similar results. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Generally, worldwide experience has been limited by multiple factors, including anatomic constraints of the proximal aorta, the lack of devices specifically designed for the ascending aorta, and the lack of disease-specific stent-graft technologies.…”

Management of Concomitant Large Aortic Aneurysm and Severe Stenosis of Aortic Arc

“…Monitoring of the blood supply in the ITA-IEA route to lower limbs may provide beneficial diagnostic information necessary for the pretreatment work-up of patients with aortoiliac occlusion. 7) Ideally, the surgeon should be cautious to try to avoid interrupting this compensatory arterial collateral pathway in order to ensure the satisfactory perfusion of the lower part of the body. In our case, the ITA-IEA was unavoidably destroyed during surgery and could not be seen on the postoperative angiogram.…”