Advanced endovascular techniques for thoracic and abdominal aortic dissections

TY - JOUR

T1 - Advanced endovascular techniques for thoracic and abdominal aortic dissections

AU - Kölbel, T

AU - Diener, H

AU - Larena-Avellaneda, A

AU - Debus, S

PY - 2013/2

Y1 - 2013/2

N2 - Endovascular treatment of aortic dissection is still in its infancy and consists usually of implantation of thoracic tubular stent-grafts to cover the proximal entry tear and redirect flow into the true lumen. Large registries comparing endovascular treatment by thoracic endovascular aortic repair (TEVAR) with open surgery for aortic dissection of the descending aorta have demonstrated a clear benefit for endovascular treatment with lower mortality and morbidity rates turning TEVAR into the standard treatment for complicated type B aortic dissection. With this momentum of success endovascular techniques continue to challenge open surgical techniques also in the aortic arch and the ascending aorta. TEVAR for aortic dissection has become more complex requiring an individualized treatment strategy as endovascular techniques have developed with the advent of new devices and increased experience of the operators. In many cases straight implantation of a thoracic tubular stent-graft is sufficient. But as rerouting of the blood flow can also change perfusion of vital side-branches the endovascular operator needs to have a large armamentarium of techniques and adjunctive procedures in order to sufficiently address the individual patient morphology. This chapter reviews a variety of endovascular techniques including access techniques, proximal sealing, the Petticoat-technique, false lumen deployment, fenestration techniques, branch vessel stenting and false lumen obstruction by various techniques.

AB - Endovascular treatment of aortic dissection is still in its infancy and consists usually of implantation of thoracic tubular stent-grafts to cover the proximal entry tear and redirect flow into the true lumen. Large registries comparing endovascular treatment by thoracic endovascular aortic repair (TEVAR) with open surgery for aortic dissection of the descending aorta have demonstrated a clear benefit for endovascular treatment with lower mortality and morbidity rates turning TEVAR into the standard treatment for complicated type B aortic dissection. With this momentum of success endovascular techniques continue to challenge open surgical techniques also in the aortic arch and the ascending aorta. TEVAR for aortic dissection has become more complex requiring an individualized treatment strategy as endovascular techniques have developed with the advent of new devices and increased experience of the operators. In many cases straight implantation of a thoracic tubular stent-graft is sufficient. But as rerouting of the blood flow can also change perfusion of vital side-branches the endovascular operator needs to have a large armamentarium of techniques and adjunctive procedures in order to sufficiently address the individual patient morphology. This chapter reviews a variety of endovascular techniques including access techniques, proximal sealing, the Petticoat-technique, false lumen deployment, fenestration techniques, branch vessel stenting and false lumen obstruction by various techniques.

KW - Aneurysm, Dissecting/diagnostic imaging

KW - Angiography, Digital Subtraction

KW - Aortic Aneurysm, Abdominal/diagnostic imaging

KW - Aortic Aneurysm, Thoracic/diagnostic imaging

KW - Aortography/methods

KW - Blood Vessel Prosthesis

KW - Blood Vessel Prosthesis Implantation/adverse effects

KW - Endovascular Procedures/adverse effects

KW - Humans

KW - Prosthesis Design

KW - Regional Blood Flow

KW - Stents

KW - Tomography, X-Ray Computed

KW - Treatment Outcome

M3 - SCORING: Review article

C2 - 23443592

VL - 54

SP - 81

EP - 90

JO - J CARDIOVASC SURG

JF - J CARDIOVASC SURG

SN - 0021-9509

IS - 1 Suppl 1

ER -