Current state and future directions of endovascular ascending and arch repairs

TY - JOUR

T1 - Current state and future directions of endovascular ascending and arch repairs

T2 - The motion towards an endovascular Bentall procedure

AU - Gouveia E Melo, Ryan

AU - Stana, Jan

AU - Prendes, Carlota Fernández

AU - Kölbel, Tilo

AU - Peterss, Sven

AU - Stavroulakis, Konstantinous

AU - Rantner, Barbara

AU - Pichlmaier, Maximilian

AU - Tsilimparis, Nikolaos

N1 - Copyright © 2022 Elsevier Inc. All rights reserved.

PY - 2022/9

Y1 - 2022/9

N2 - Endovascular repair of the ascending aorta and aortic arch has evolved at an astonishing pace in the past several decades. Results of endovascular arch repair in experienced centers have been improving and the technology evolving, and it has begun to challenge the current gold standard status of open surgery in some groups of patients. Hybrid strategies with adjunctive cervical debranching for distal arch lesions are being replaced by fenestrated arch repairs. Total endovascular repair for proximal aortic arch pathologies with the use of inner branches has achieved the best results; however, the main current limitations of endovascular arch repair are diameter-, length-, and angulation-related issues with the ascending aorta (proximal landing zone). Ascending aorta endovascular repair has allowed extending treatment further proximally in patients with post-surgical pseudoaneurysms of the ascending aorta or post-type A chronic aortic dissections. However, sufficient proximal landing zone is still needed in the proximal aorta for these repairs; in a significant number of patients, this is not feasible with simple proximal tubular grafts. Therefore, new technologies and techniques are being developed to deal with this limitation, including the endovascular Bentall concept, with incorporation of the aortic valve and coronary ostia. In this review, the current state and future directions of endovascular ascending and arch repairs and the motion towards an endovascular Bentall procedure are discussed.

AB - Endovascular repair of the ascending aorta and aortic arch has evolved at an astonishing pace in the past several decades. Results of endovascular arch repair in experienced centers have been improving and the technology evolving, and it has begun to challenge the current gold standard status of open surgery in some groups of patients. Hybrid strategies with adjunctive cervical debranching for distal arch lesions are being replaced by fenestrated arch repairs. Total endovascular repair for proximal aortic arch pathologies with the use of inner branches has achieved the best results; however, the main current limitations of endovascular arch repair are diameter-, length-, and angulation-related issues with the ascending aorta (proximal landing zone). Ascending aorta endovascular repair has allowed extending treatment further proximally in patients with post-surgical pseudoaneurysms of the ascending aorta or post-type A chronic aortic dissections. However, sufficient proximal landing zone is still needed in the proximal aorta for these repairs; in a significant number of patients, this is not feasible with simple proximal tubular grafts. Therefore, new technologies and techniques are being developed to deal with this limitation, including the endovascular Bentall concept, with incorporation of the aortic valve and coronary ostia. In this review, the current state and future directions of endovascular ascending and arch repairs and the motion towards an endovascular Bentall procedure are discussed.

KW - Aortic Dissection/surgery

KW - Aorta, Thoracic/diagnostic imaging

KW - Aortic Aneurysm, Thoracic/diagnostic imaging

KW - Blood Vessel Prosthesis

KW - Blood Vessel Prosthesis Implantation/adverse effects

KW - Endovascular Procedures/adverse effects

KW - Humans

KW - Retrospective Studies

KW - Stents

KW - Treatment Outcome

U2 - 10.1053/j.semvascsurg.2022.07.001

DO - 10.1053/j.semvascsurg.2022.07.001

M3 - SCORING: Review article

C2 - 36153076

VL - 35

SP - 350

EP - 363

JO - SEMIN VASC SURG

JF - SEMIN VASC SURG

SN - 0895-7967

IS - 3

ER -