Endovascular treatment of aortic aneurysms and dissections in patients with genetically triggered aortic diseases
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Endovascular treatment of aortic aneurysms and dissections in patients with genetically triggered aortic diseases. / Spanos, Konstantinos; Kodolitsch, Yskert von; Detter, N Christian; Panuccio, Giuseppe; Rohlffs, Fiona; Eleshra, Ahmed; Kölbel, Tilo.
In: SEMIN VASC SURG, Vol. 35, No. 3, 09.2022, p. 320-333.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Endovascular treatment of aortic aneurysms and dissections in patients with genetically triggered aortic diseases
AU - Spanos, Konstantinos
AU - Kodolitsch, Yskert von
AU - Detter, N Christian
AU - Panuccio, Giuseppe
AU - Rohlffs, Fiona
AU - Eleshra, Ahmed
AU - Kölbel, Tilo
N1 - Copyright © 2022 Elsevier Inc. All rights reserved.
PY - 2022/9
Y1 - 2022/9
N2 - Connective tissue disease (CTD) syndromes involve the ascending, aortic arch, and thoracoabdominal aorta and are associated with higher risk of aortic aneurysm or dissection. Currently, vascular societies generally recommend open repair as the first option for aortic disease in patients with CTD. However, the implementation of endovascular techniques for patients with CTD with aortic pathologies seems to have increased in recent years, mainly in patients of high surgical risk or in urgent situations. Endovascular treatment of aortic arch pathologies in patients with CTD have been feasible in experienced centers; however, the evidence is scarce. Thoracic endovascular aneurysm repair in patients with CTD is more evident; in 15 studies, 304 patients with CTD were treated with thoracic endovascular aneurysm repair with high technical success rates (88% to 100%) and a low early mortality rate (1.6%). During the median follow-up, 33 patients died and 64 patients underwent a re-intervention. In 6 studies, 26 patients with CTD were treated with fenestrated/branched endovascular aneurysm repair for thoracoabdominal aortic aneurysm, with a technical success rate of 100%, without early mortality and morbidity. The endovascular approach to thoracoabdominal aortic aneurysm, especially in post-dissection patients, mandates adjunctive techniques to achieve false lumen thrombosis with various approaches; in our experience, the Candy-Plug technique has been proven to be technically feasible with good outcomes. Endovascular treatment of aortic pathologies in patients with CTD seems to be feasible and safe in high-risk and urgent patients. Re-intervention remains an issue. The constant development of endovascular techniques and devices may provide improved mortality and morbidity outcomes.
AB - Connective tissue disease (CTD) syndromes involve the ascending, aortic arch, and thoracoabdominal aorta and are associated with higher risk of aortic aneurysm or dissection. Currently, vascular societies generally recommend open repair as the first option for aortic disease in patients with CTD. However, the implementation of endovascular techniques for patients with CTD with aortic pathologies seems to have increased in recent years, mainly in patients of high surgical risk or in urgent situations. Endovascular treatment of aortic arch pathologies in patients with CTD have been feasible in experienced centers; however, the evidence is scarce. Thoracic endovascular aneurysm repair in patients with CTD is more evident; in 15 studies, 304 patients with CTD were treated with thoracic endovascular aneurysm repair with high technical success rates (88% to 100%) and a low early mortality rate (1.6%). During the median follow-up, 33 patients died and 64 patients underwent a re-intervention. In 6 studies, 26 patients with CTD were treated with fenestrated/branched endovascular aneurysm repair for thoracoabdominal aortic aneurysm, with a technical success rate of 100%, without early mortality and morbidity. The endovascular approach to thoracoabdominal aortic aneurysm, especially in post-dissection patients, mandates adjunctive techniques to achieve false lumen thrombosis with various approaches; in our experience, the Candy-Plug technique has been proven to be technically feasible with good outcomes. Endovascular treatment of aortic pathologies in patients with CTD seems to be feasible and safe in high-risk and urgent patients. Re-intervention remains an issue. The constant development of endovascular techniques and devices may provide improved mortality and morbidity outcomes.
KW - Aortic Dissection/diagnostic imaging
KW - Aortic Aneurysm, Abdominal/surgery
KW - Aortic Aneurysm, Thoracic/diagnostic imaging
KW - Blood Vessel Prosthesis
KW - Blood Vessel Prosthesis Implantation
KW - Connective Tissue Diseases/complications
KW - Endovascular Procedures
KW - Humans
KW - Prosthesis Design
KW - Retrospective Studies
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1053/j.semvascsurg.2022.06.001
DO - 10.1053/j.semvascsurg.2022.06.001
M3 - SCORING: Review article
C2 - 36153073
VL - 35
SP - 320
EP - 333
JO - SEMIN VASC SURG
JF - SEMIN VASC SURG
SN - 0895-7967
IS - 3
ER -
