Emergent endovascular treatment options for thoracoabdominal aortic aneurysm

TY - JOUR

T1 - Emergent endovascular treatment options for thoracoabdominal aortic aneurysm

AU - Grandi, Alessandro

AU - Melloni, Andrea

AU - D'Oria, Mario

AU - Lepidi, Sandro

AU - Bonardelli, Stefano

AU - Kölbel, Tilo

AU - Bertoglio, Luca

N1 - Copyright © 2023 Elsevier Inc. All rights reserved.

PY - 2023/6

Y1 - 2023/6

N2 - For a long time, parallel grafting, physician-modified endografts, and, more recently, in situ fenestration were the only go-to endovascular options for ruptured thoracoabdominal aortic aneurysm, offered mixed results, and depended mainly on the operator's and center's experience. As custom-made devices have become an established endovascular treatment option for elective thoracoabdominal aortic aneurysm, they are not a viable option in the emergency setting, as endograft production can take up to 4 months. The development of off-the-shelf (OTS) multibranched devices with a standardized configuration has allowed the treatment of ruptured thoracoabdominal aortic aneurysm with emergent branched endovascular procedures. The Zenith t-Branch device (Cook Medical) was the first readily available graft outside the United States to receive the CE mark (in 2012) and is currently the most studied device for those indications. A new device, the E-nside thoracoabdominal branch endoprosthesis OTS multibranched endograft (Artivion), has been made commercially available, and the GORE EXCLUDER thoracoabdominal branch endoprosthesis OTS multibranched endograft (W. L. Gore and Associates) is expected to be released in 2023. Due to the lack of guidelines on ruptured thoracoabdominal aortic aneurysm, this review summarizes the available treatment options (ie, parallel grafts, physician-modified endografts, in situ fenestrations, and OTS multibranched devices), compares the indications and contraindications, and points out the evidence gaps that should be filled in the next decade.

AB - For a long time, parallel grafting, physician-modified endografts, and, more recently, in situ fenestration were the only go-to endovascular options for ruptured thoracoabdominal aortic aneurysm, offered mixed results, and depended mainly on the operator's and center's experience. As custom-made devices have become an established endovascular treatment option for elective thoracoabdominal aortic aneurysm, they are not a viable option in the emergency setting, as endograft production can take up to 4 months. The development of off-the-shelf (OTS) multibranched devices with a standardized configuration has allowed the treatment of ruptured thoracoabdominal aortic aneurysm with emergent branched endovascular procedures. The Zenith t-Branch device (Cook Medical) was the first readily available graft outside the United States to receive the CE mark (in 2012) and is currently the most studied device for those indications. A new device, the E-nside thoracoabdominal branch endoprosthesis OTS multibranched endograft (Artivion), has been made commercially available, and the GORE EXCLUDER thoracoabdominal branch endoprosthesis OTS multibranched endograft (W. L. Gore and Associates) is expected to be released in 2023. Due to the lack of guidelines on ruptured thoracoabdominal aortic aneurysm, this review summarizes the available treatment options (ie, parallel grafts, physician-modified endografts, in situ fenestrations, and OTS multibranched devices), compares the indications and contraindications, and points out the evidence gaps that should be filled in the next decade.

KW - Humans

KW - Blood Vessel Prosthesis

KW - Blood Vessel Prosthesis Implantation/adverse effects

KW - Aortic Aneurysm, Thoracoabdominal

KW - Aortic Aneurysm, Thoracic/diagnostic imaging

KW - Treatment Outcome

KW - Prosthesis Design

KW - Stents

KW - Endovascular Procedures

KW - Aortic Rupture/diagnostic imaging

KW - Aortic Aneurysm, Abdominal/surgery

U2 - 10.1053/j.semvascsurg.2023.04.004

DO - 10.1053/j.semvascsurg.2023.04.004

M3 - SCORING: Review article

C2 - 37330232

VL - 36

SP - 174

EP - 188

JO - SEMIN VASC SURG

JF - SEMIN VASC SURG

SN - 0895-7967

IS - 2

ER -