Surgical Management of Descending Thoracic Aortic Disease: Open and Endovascular Approaches

Coady, Michael A.; Ikonomidis, John S.; Cheung, Albert T.; Matsumoto, Alan H.; Dake, Michael D.; Chaikof, Elliot L.; Cambria, Richard P.; Mora-Mangano, Christina; Sundt, Thoralf M.; Sellke, Frank W.

doi:10.1161/cir.0b013e3181e4d033

Cited by 178 publications

(119 citation statements)

References 110 publications

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“…44e50 An additional meta-analysis reported an almost doubled rate of cerebrovascular events (4 An inadequate distal landing zone of less than 15 mm length and a proximal neck diameter exceeding 40 mm are contraindications for TEVAR with currently available devices. 215,220 These anatomical limitations occurred more commonly than the rate of 4.4% previously reported in a multicentre review of TEVAR. 220 In spite of these data, safe coverage of the CA has been described to achieve acceptable distal sealing and fixation.…”

Section: Recommenda On 39mentioning

confidence: 88%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

948

259

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Section: Recommenda On 39mentioning

confidence: 88%

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau¹,

Böckler²,

Brunkwall³

et al. 2017

European Journal of Vascular and Endovascular Surgery

948

259

View full text Add to dashboard Cite

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“…For validation of the long-term durability and efficacy of our strategy, careful follow-up will be essential. 7) conclusIon Multiple-stage surgeries including endografting were found to be useful for overcoming anatomical difficulties in patients with RAA. Bilateral recurrent nerve palsy after total arch replacement can be critical, and the use of TEVAR after supra-aortic bypass may, therefore, be preferable for patients with RAA.…”

Section: Discussionmentioning

confidence: 99%

Hybrid Repair Combined with Open Surgery and Endografting for Lesions in Right Aortic Arch: Report of Three Cases

Sato

Matsuda

Fukuda

et al. 2012

Annals of Vascular Diseases

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Three cases with lesions in the right aortic arch (RAA) are presented. For two patients, whose RAA contained a retroesophageal segment, the primary treatment was total arch replacement (TAR) for acute type A dissection or severe arch angulation with thoracic endovascular aneurysm repair (TEVAR) as second-stage surgery. The third patient, who had RAA with mirror image branching, underwent supraaortic bypass followed by TEVAR. There was no operative mortality, but the condition of two patients who underwent TAR was complicated by bilateral recurrent nerve palsy, which can be critical. The combination of TEVAR and supra-aortic bypass might thus be preferable for patients with RAA.

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“…Historically, open repair of thoracic aneurysmal diseases is associated with a perioperative mortality rate ranging from 12% -44%, depending on the urgency of repair and patient co-morbidity [3]. Hence, stent-grafting may seem an attractive alternative with better outcomes in the shortterm.…”

Section: Aneurysmal Diseasesmentioning

confidence: 99%

“…Nine of these interventions were for uncomplicated dissections. While medical therapy alone for uncomplicated dissections is associated with 84% survival at one year, mortality is 30% -50% at 5 years and at 4 years 20% -50% will experience delayed expansion of the false lumen [3,11]. False aneurysms in a dissected aorta can grow significantly faster than degenerative aneurysms of an undissected aorta and the risk of rupture is greater at smaller aortic diameters.…”

Section: Aortic Dissectionmentioning

confidence: 99%

“…These patients, with an average age of 47 were significantly younger than the treated patients with degenerative thoracic aneurysms (average age 68) or aortic dissection (average age 62). Implanting stent-grafts, which have been designed to have a durability of 10 years [3], in relatively young patients will require vigilant follow up and reporting since patients in this group may live long enough to develop unique complications. As the thoracic aorta normally enlarges with age [18], this subgroup of patients may require re-interventions remote from the initial procedure.…”

Section: Traumatic Aortic Transectionmentioning

confidence: 99%

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

Hoenig¹,

Jenkins²,

Boyne³

et al. 2012

WJCS

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Objectives: To describe thoracic endovascular aortic repair (TEVAR) outcomes at the Royal Brisbane and Women's Hospital between [2001][2002][2003][2004][2005][2006][2007][2008][2009][2010]. Design: Prospective cohort study. Results: We successfully treated 95 of 97 patients for a 98% procedural success rate. Of the treated patients, 68 (72%) were males and mean age was 61 ± 17 years. Average follow up was 3.6 ± 2.0 years. Pathologies treated were: dissection (n = 35), aneurysmal disease (n = 32), traumatic disease (n = 19), coarctation (n = 5) and miscellaneous (n = 4). There was one peri-procedural myocardial infarction. Renal complications occurred in 7 patients (3 with doubling creatinine and 4 requiring temporary renal replacement therapy). Stroke occurred in 2 patients and paresis in 2 patients (permanent in one). Six patients died during index hospitalization and 17 deaths occurred during follow-up, 2 of which were confirmed secondary to aortic pathology. Age (HR 1.08 per year, p < 0.01) and ASA class (HR 2.2 per class, p = 0.02) were independently associated with mortality. There were 25 re-interventions in 22 patients. Eighteen of these re-interventions in 16 patients were related to the management of complications of TEVAR of which 13 were for endoleaks; eight type I, four type II, one type III. Conclusion: TEVAR can be used to treat thoracic aortic pathology but questions remain regarding long-term durability.

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Surgical Management of Descending Thoracic Aortic Disease: Open and Endovascular Approaches

Cited by 178 publications

References 110 publications

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Hybrid Repair Combined with Open Surgery and Endografting for Lesions in Right Aortic Arch: Report of Three Cases

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

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