Thoracic Endovascular Aortic Repair of Aortic Arch Pathologies with the Conformable Thoracic Aortic Graft: Early and 2 year Results from a European Multicentre Registry

Abstract

The CTAG stent graft shows high deployment accuracy, good conformability, and clinical effectiveness in the treatment of aortic arch pathologies. However, thoracic endovascular aortic repair in the arch is associated with a relatively high stroke rate. Further studies with more patients and longer follow up are needed to evaluate the long-term results.

A current systematic evaluation and meta-analysis of chimney graft technology in aortic arch diseases

“…Another example of the high stroke rate is the multicenter study (also including ourselves) published by Böckler et al, 32 in which the stroke rate after TEVAR without chimney and with a landing zone in the distal arch was 11% at 30 days. A lower rate, though, was seen in the study by Chiesa et al, 33 in which the 30-day mortality rate was 4.5% and the stroke rate was 3.4% in 179 patients who were treated with endografts for aortic arch diseases.…”

Commentary on ‘Thoracic Endovascular Aortic Repair (TEVAR) of Aortic Arch Pathologies with the Conformable Gore ® TAG ® – Early and 2 Year Results from a European Multicentre Registry’

“…2 At 2 years, overall survival was 73% and the endoleak free survival 87% in a population of 100 patients undergoing CTAG repair for various and mainly high complexity thoracic diseases spanning from proximal landing zones 0 to 3 of the arch and also including emergencies (type B dissection, aneurysms, penetrating ulcers, traumatic transection). 2 The technical success rate was 92% with 99% accuracy and 95% conformability, and only 2% peri-operative type I endoleaks were detected.…”

“…Older patients were more at risk. 2 Although improved knowledge of spinal cord perfusion has allowed for effective protective strategies and useful adjuncts to prevent paraplegia in thoracic aorta repairs (both the US and European CTAG registries reported 3e4% paraplegia rates), stroke remains the worst enemy of arch diseases repair.…”

The Modified Arch Landing Areas Nomenclature (MALAN) Improves Prediction of Stent Graft Displacement Forces: Proof of Concept by Computational Fluid Dynamics Modelling

“…Thoracic endovascular aortic repair (TEVAR) is currently the first line treatment for aortic disease affecting the descending thoracic aorta, because in selected patients 1 it provides low procedural morbidity and mortality, and satisfactory mid-term results. Endovascular procedures involving the aortic arch, however, are associated with higher rates of post-operative clinical failure, 2 and remain complex and challenging because of the angulation and tortuosity of the arch and its peculiar biomechanical environment. 3 Pre-operative planning for TEVAR of the arch is based on Ishimaru's classification, 4 which disregards landing zone angulation and tortuosity that represent critical anatomical features associated with higher rates of endograft failure.…”