Endovascular treatment of thoracic aortic aneurysms: a review

Abstract

Open surgical repair is considered the traditional treatment for patients with thoracic aortic aneurysms (TAA). In view of the persistent perioperative mobidity and mortality, endovascular stent-graft placement as a minimally invasive and potentially safer treatment for aneurysm of the descending aorta was introduced in 1992. Since then, progress has been made and several institutions have substantiated the safety and effectiveness of stent grafts in the repair of descending TAAs or type-B aortic dissections. Currently, both custom-designed, home-made, and commercially available stent grafts are used. Prior to placement of the endoprosthesis, three major prerequisites must be considered: the localization and morphology of the aneurysm; the distal vascular access of sufficient size; and a limited tortuosity of the abdominal and thoracic aorta. Although short-term results are encouraging, severe complications, including paraplegia, cerebral strokes, and aortic rupture, have been encountered. The long-term durability of currently available stent-graft systems is nonexistent and material fatigue are of major concern to both surgeons and radiologists. Nevertheless, endovascular stent-graft placement could become the procedure of choice in a substantial number of patients with descending TAA.

Endovascular Repair of Abdominal and Thoracic Aortic Aneurysms

“…However, their observed frequency is substantially less than that reported for AAA endograft repair. 93 Interestingly, the distribution of endoleak types also differs. TAA endoleaks occur more commonly at the proximal or distal attachment sites (type I endoleak), whereas the majority of AAA endoleaks are type II.…”

Urgent thoracic aortal dissection and aneurysm: treatment with stent-graft implantation in an angiographic suite

“…The preoperative screening of the patient with a multidetector CT angiography scan from the apex of the thorax down to the groin facilitates procedural planning as well as sizing of the endograft. With this technique calibrated intra-arterial DSA, as suggested by Thurnher and Grabenwöger [22], is not necessary any more. The occurrence of endoleaks, aortic neck dilation, and stent-graft migration remains a cause for extreme concern, and further evaluation of this new technique is indicated to determine its effectiveness and durability in the longer term.…”

Aneurysmen und Dissektionen der thorakalen und abdominellen Aorta

“…Sekundäre Aneurysmarupturen sind mit 1,6% beschrieben, Graftmigration und strukturelle Defekte zeigen sich in 2,8% der Fälle [19]. [40]. Im Nachsorgeintervall nach TEVAR zeigt sich ein Einjahresüberleben von 89,5%, stentassoziierte Komplikationen nach 2 Jahren zeigen sich in 38% der Fäl-le.…”