Endovascular management of chronic aortic dissection in patients with Marfan syndrome

Abstract

TEVR in Marfan syndrome patients with chronic aortic dissection is technically feasible. However, post intervention surveillance confirms that the aorta continues to dilate despite graft deployment and false lumen thrombosis. Endovascular repair may offer a viable option in patients who have contraindications to open surgery, but longer follow up of more patients is required to define the place of this therapy.

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…99 The available literature regarding TEVAR for chronic dissection in patients with MFS is sparse. 193 Early technical feasibility has been demonstrated, but long-term outcomes remain uncertain. The fragility of the aorta in MFS and other associated conditions poses a problem for proximal aortic fixation and may lead to the development of complications (see also Section 3.7.1.1.…”

“…The evidence for thoracic endovascular repair in MFS is much more limited, with only small series and registry or case reports including a heterogeneous group of patients with only short-term follow up. 193 More recently, particularly in patients with an increased surgical risk because of redo sternotomy or thoracotomy, a gradual move to endovascular repair has been observed, but this approach cannot be recommended for routine use in patients with MFS.…”

Experience with Thoracic Aortic Stent-Grafting at the Royal Brisbane and Women’s Hospital: Outcomes from the First Decade

“…In this series, stent-grafts were deployed to arrest aneurysmal degeneration in Marfan patients with chronic dissections. The thoracic aorta continued to dilate at an alarming average of 7 mm per year despite successful TEVAR of the entry tear and thrombosis of the false lumen [21]. However, the apparently …”

Endovascular Repair by Graft-to-Graft Bridging in a Patient with Marfan Syndrome

“…This is because the stent graft was deployed into a replacement aortic segment that provided a stable platform, which reduced the incidence of type 1 endoleaks. 5) We believe that it is not sufficient to just prevent dilation of the dissected aorta, because it is possible that progression of dissection or new dissection might be induced by the radial forces of the stent graft on the aortic wall when the distal landing zone is in the dissected aorta. Then a mismatch between the stent graft and aortic wall could occur, resulting in endoleak.…”