Endovascular Management of the Ascending Aorta: State of the Art

Atkins, Aidan D.; Reardon, Michael J.; Atkins, Marvin D.

doi:10.14797/mdcvj.1173

Cited by 11 publications

(4 citation statements)

References 17 publications

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“…Aorticrelated events following TEVAR may require further reintervention with aneurysmal degeneration, endoleaks, and distal SINEs commonly cited as causes. [99][100][101][102][103][104] Much of the outcome data currently available are limited to follow-up of 5 years or less. One recent single-center study has released results out to 12 years, showing aorta-specific survival of 96% with a 7% reintervention rate for endoleak in patients with DTAA.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Endovascular Repair of Thoracic Aortic Aneurysms

Gorton,

Keshavamurthy,

Saha

2024

Int J Angiol

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The thoracic aorta is a dynamic structure composed of the aortic root, ascending aorta, aortic arch, and descending aorta. It is subject to the pressure and volume of the cardiac cycle and susceptible to atherosclerotic and aneurysmal changes. With these changes, the risk for acute aortic syndromes increases, thus creating the impetus for earlier interventions. The previous standard of open surgical repair has undergone a transition in recent years toward endovascular repair being favored in the descending and abdominal aortas with ongoing investigation into approaches for the ascending and aortic arch. These therapies have been shown to improve early mortality and morbidity outcomes with the caveat of more interventions compared with open surgery. We undertook this review to analyze the current data available regarding long-term outcomes in patients undergoing endovascular repair for thoracic aortic disease. The data support long-term benefit of endovascular repair for thoracic aortic disease. The primary indications identified for reintervention are endoleak and further aneurysmal degeneration. As the devices available for endovascular repair evolve, ongoing review of these outcomes will be necessary. It will also be important to trend the results as further techniques become available for endovascular repair of the ascending aorta and aortic arch.

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Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Endovascular Repair of Thoracic Aortic Aneurysms

Gorton,

Keshavamurthy,

Saha

2024

Int J Angiol

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“…La fase preclínica en el estudio de AA ha tomado importancia y constituye una parte fundamental con la utilización de modelos animales como base de la investigación de los mecanismos fisiopatológicos relacionados con el desarrollo de esta entidad. En las últimas tres décadas ha tomado una mayor relevancia debido a la disminución en la disponibilidad de tejido aórtico humano por el manejo menos invasivo desde la implementación de las técnicas endovasculares 12 .…”

Section: Discussionunclassified

“…A medida que los tratamientos endovasculares sustituyen al abordaje quirúrgico abierto como primera línea de tratamiento 12 , menos disposición de tejido humano está disponible para su investigación. Los distintos modelos empleados para el estudio de AA han permitido realizar experimentos para un mayor entendimiento de esta entidad.…”

Section: Introductionunclassified

Desarrollo, técnicas y utilidad de modelos animales experimentales de aneurismas aórticos torácicos y abdominales

Bravo-Reyna,

Mejía-Cervantes,

Verduzco-Vázquez

et al. 2024

ACM

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Los aneurismas son una de las entidades clínicas que pueden desarrollarse y afectar la aorta humana. Aunque en la mayoría de los casos tienen un carácter asintomático, estas dilataciones patológicas pueden resultar letales cuando se presentan con ruptura, por lo que el reconocimiento de factores predictores de esta complicación es crucial para evitar muertes. Fisiopatológicamente se han identificado eventos esenciales que ocurren en la pared del vaso, como inflamación, proteólisis, apoptosis del músculo liso, angiogénesis y remodelación. Las grandes especies como porcinos y ovinos han sido de utilidad para el desarrollo y evaluación del desempeño de dispositivos endovasculares en la aorta, así como la remodelación; con el advenimiento y disposición de estas técnicas mínimamente invasivas para su reparación existe una menor disponibilidad de tejido aórtico para el análisis molecular, celular e histopatológico, por lo que en las últimas tres décadas se han propuesto e introducido distintos modelos que han permitido, mediante la inducción focal de estas lesiones, el estudio de los mecanismos fisiopatológicos y posibles biomarcadores de utilidad como dianas diagnósticas y terapéuticas. El presente artículo de revisión aborda tipos de modelos animales disponibles, así como sus aplicaciones, consideraciones, ventajas y limitaciones para el desarrollo de estudios preclínicos y su importancia en el entendimiento de esta patología en la especie humana.

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“…Advanced endovascular options for the acute and chronic pathology of the ascending aorta are emerging and have reached the clinical arena [1,2]. Observations in small case series and registries have identified several problems with stent grafts placed in the ascending aorta in patients who are not candidates for surgical repair, such as migration and erosion at the stent graft and aorta interface [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Nonsurgical Repair of the Ascending Aorta: Why Less Is More

Yuan

Kan

Dong

et al. 2023

JCM

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Objective: Advanced endovascular options for acute and chronic pathology of the ascending aorta are emerging; however, several problems with stent grafts placed in the ascending aorta have been identified in patients unsuitable for surgical repair, such as migration and erosion at aorta interface. Method: Among the six cases analysed in this report, three were treated with a stent graft in the ascending aorta to manage chronic dissection in the proximal aorta; dimensions of those stent grafts varied between 34 and 45 mm in diameter, and from 77 to 100 mm in length. Three patients, matched by age, sex and their nature of pathology, were subjected to the focal closure of a single communicating entry by the use of an occluding device (Amplatzer ASD and PFO occluders between 14 and 18 mm disc diameter) with similar Charlson comorbidity score. Results: Both conceptually different nonsurgical management strategies were technically feasible; however, with stent grafts, an early or delayed erosion to full re-dissection was documented with stent grafts, in contrast to complete seal, with an induced remodelling and a long-term survival after the successful placing of coils and occluder devices. Moreover, aortic root motion was not impaired by the focal occlusion of a communication with an occluder, while free motion was impeded after stent graft placement. Conclusions: The intriguing observation in our small series was that stent grafts placed in the ascending aorta portends the risk of an either early (post-procedural) or delayed migration and erosion of aortic tissues at the landing site or biological interface between 12 and 16 months after the procedure, a phenomenon not seen with the use of focal occluding devices up to 5 years of follow-up. Obviously, the focal approach avoids the erosion of the aortic wall as the result of minimal interaction with the biological interface, such as a diseased aortic wall. Potential explanations may be related to a reduced motion of the aortic root after the placement of stent graft in the ascending aorta, whereas the free motion of aortic root was preserved with an occluder. The causality of erosion may however not be fully understood, as besides the stiffness and radial force of the stent graft, other factors such as the induced inflammatory reactions of aortic tissue and local adhesions within the chest may also play a role. With stent grafts failing to portend long-term success, they may still have a role as a temporizing solution for elective surgical conversion. Larger datasets from registries are needed to further explore this evolving field of interventions to the ascending aorta.

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Endovascular Management of the Ascending Aorta: State of the Art

Cited by 11 publications

References 17 publications

Long-Term Outcomes of Endovascular Repair of Thoracic Aortic Aneurysms

Long-Term Outcomes of Endovascular Repair of Thoracic Aortic Aneurysms

Desarrollo, técnicas y utilidad de modelos animales experimentales de aneurismas aórticos torácicos y abdominales

Nonsurgical Repair of the Ascending Aorta: Why Less Is More

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