Technical Strategies to Expand Stent-Graft Applicability in the Aortic Arch and Proximal Descending Thoracic Aorta

Abstract

The endovascular repair of thoracic aortic pathology is on an evolutionary threshold, as advancing technologies and techniques combine to offer the interventionist expanded treatment opportunities. A variety of maneuvers are recommended to address the landing zone limitations to thoracic endografting imposed by the arch vessels: transostial bare stent placement, intentional occlusion of the arch vessel origin, vessel transposition, and bypass grafting. These adjunctive techniques can help us extend the option of a minimally invasive treatment to a greater number of patients with severe thoracic aortic lesions and comorbidities that place them at high risk for standard surgical intervention. J Endovasc Ther 2002;9:II-32-II-38

The Vienna aneurysm program

“…Additionally, the potential risk of clot formation on the artificial surface of an alloplastic vascular prosthesis is avoided. Nevertheless, several authors have described excellent results with alloplastic reconstructions in this particular subgroup of patients [45][46][47][48]52].…”

“…Due to the novelty of such procedures, few data are available with regard to mid-term and long-term patency rates [45][46][47][48]52]. Our mean follow-up period is 20 months [range 1-54 months].…”

“…However, in case of involvement of the aortic arch, innovative vascular surgical approaches to maintain cerebral perfusion have been warranted and have been developed to enable safe and effective endovascular arch repair [44][45][46][47][48]. Depending onto the extent of the pathology within the arch, autologous approaches or approaches using alloplastic graft material to maintaining cerebral perfusion may be used.…”

Réparation endovasculaire de l'aorte thoracique et revascularisation de la crosse

“…Hughes et al 9 ont fait des pontages carotido-carotidiens ant erieurs mais ont mentionn e qu'ils avaient eu la chance qu'aucune trach eotomie n'ait et e n ecessaire. Depuis le d ebut des ann ees 90, Criado et al 10,11 ont fait des pontages r etro-pharyngiens, initialement pour traiter des l esions occlusives des troncs supraaortiques, avec des r esultats favorables, puis principalement pour des d ebranchements des branches de la crosse aortique chez des patients ayant TEVAR et le besoin d'une reconstruction de l'ASCG. Nous evitons le trajet sous-cutan e carotido-carotidien pour le d ebranchement chez les patients dont l' evaluation pr eop eratoire sugg ere qu'une insuffisance respiratoire postop eratoire puisse se produire parce que nous pensons que ceci peut eviter une proc edure invasive additionnelle telle que le changement d'art ere donneuse.…”

Hybrid procedures as a combined endovascular and open approach for pararenal and thoracoabdominal aortic pathologies

“…The management of vascular diseases has rapidly evolved into a hybrid speciality combining open and endovascular techniques. As well as reports of endoluminal repair of aortic arch combined with revascularization of supraaortic arteries [1][2][3][4][5] early experience with thoracoabdominal aneurysms (TAAA) treated by a combination of open and endoluminal surgery has been reported [6][7][8][9][10][11]. The management of TAAAs is challenging, especially in highrisk patients.…”