The Role of Thoracic Endovascular Aortic Repair (TEVAR) of Thoracic Aortic Diseases in Patients with Connective Tissue Disorders – A Literature Review

Harky, Amer; Hussain, Syed Mohammad Asim; MacCarthy‐Ofosu, Beverly; Ahmad, Maqbool

doi:10.21470/1678-9741-2019-0367

Cited by 14 publications

(6 citation statements)

References 62 publications

(21 reference statements)

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“…30 This study had improved outcome compared to previous report. 27,[31][32][33] This could be probably explained by the relatively younger age of cohort; lower number of acute dissection cases with its impact on high retrograde dissection, endoleak, and re-intervention; and the use of dedicated device with a lower radial force in the distal graft end and probably by different amount in oversizing 22 or greater percentage of landing within synthetic grafts.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Aortic Pathologies in Patients With Marfan Syndrome: Single-Center Experience

Kölbel¹,

Eleshra²,

Aldağ³

et al. 2021

J Endovasc Ther

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Objectives: To study the outcome of endovascular treatment of aortic pathologies in patients with Marfan syndrome (MFS) at a single institution. Methods: Consecutive MFS patients who underwent endovascular repair or hybrid procedures for aortic pathologies from January 2010 to May 2020 were identified. Several endovascular and hybrid strategies have been used. Technical success, short- and mid-term survival, complications, and re-interventions were retrospectively analyzed. Results: During the study period, 24 patients with MFS (median age, 48 [13–78] years; 58% males) were treated. Indications for intervention were chronic aortic dissection with aneurysm degeneration in 16 patients (67%), acute type B aortic dissection in 4 patients (17%), aortic aneurysm without any dissection in 3 patients (13%), and aortic intramural hematoma in 1 patient (4%). Most patients were asymptomatic (83%), three (13%) were symptomatic and one (4%) had a contained rupture. The median aneurysm diameter was 56 (35–86) mm. Hybrid procedures were performed in 7 (29%) patients. Thoracic endovascular repair was performed in 12 (50%) patients, a fenestrated or branched endovascular aortic repair in 4 (17%) patients, and placement of an iliac artery stent-graft in 1 (4%) patient. Procedures were staged in 12 (50%) patients. Technical success was achieved in all patients. The median intensive care unit stay was 6 (range, 1–30) days, and the median hospital stay was 23 (range, 3–112) days. Early mortality was reported in 1 (4%) patient. Wound infection was seen in 7 (29%) patients and gastrointestinal complications in 3 (13%) patients. The median follow-up was 42 (range, 1–127) months. The cumulative survival rate was 87% at 24 months. The cumulative freedom from re-intervention was 77% at 12 months. Conclusions: Endovascular treatment of aortic pathologies in patients with MFS appears feasible with acceptable early and mid-term outcomes in terms of mortality and re-intervention rates. Endovascular therapy plays an increasing role in MFS patients with aortic pathology.

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Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Aortic Pathologies in Patients With Marfan Syndrome: Single-Center Experience

Kölbel¹,

Eleshra²,

Aldağ³

et al. 2021

J Endovasc Ther

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“…17 Generally, open surgical repair is recommended in connective tissue disease patients such as type IV EDS, and transcatheter interventions are generally not first-line therapy. 18,19 Endovascular procedures, when specifically indicated, must be undertaken judiciously. Care must be exercised to minimize vascular injury including during access.…”

Section: Discussionmentioning

confidence: 99%

Early and Late Outcomes of Cardiovascular Surgery in Patients With Ehlers-Danlos Syndrome

Elsisy

Pochettino

Dearani

et al. 2021

World J Pediatr Congenit Heart Surg

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Background Cardiovascular surgical outcomes reports are few for vascular type IV of Ehlers- Danlos Syndrome (vEDS) compared to non-vascular types I-III (nEDS). Methods To define cardiovascular surgical outcomes among adult patients (≥18 years) with EDS types, a review of our institution's in-house STS Adult Cardiac Surgery Database-compliant software and electronic medical records from Mayo Clinic (1993–2019) was performed. Outcomes were compared for vEDS patients and nEDS patients. Demographics, baseline characteristics, operative, in-hospital complications and follow-up vital status were analyzed. Results Over the study time frame, 48 EDS patients underwent surgery (mean age 52.6 ± 14.6 years; 48% females). Of these, 17 patients had vEDS and 31 patients had nEDS. Six patients (12.5%) underwent prior sternotomy. Urgent or emergent surgery was performed in 10 patients (20.8%). Aortic (vEDS 76.5% vs. nEDS 16.1%) and mitral procedures (vEDS 11.8% vs. nEDS 48.4%) were the two most common cardiovascular surgeries performed (p < .01 and p = .007, respectively). Cardiopulmonary bypass time (CPB) (165 ± 18 vs. 90 ± 13 min; p = .015) and aortic cross clamp times (140 ± 14 vs. 62 ± 10 min; p < .001) were longer for vEDS patients. There was 1 (2.1%) early and 7 (14.6%) late deaths; 6 among vEDS and 2 among nEDS patients. Survival at 5 (80% vs. 93%), 10 (45% vs. 84%) and 15 years (45% vs. 84%) was lower in patients with vEDS (p = .015 for each comparison). Conclusion Cardiovascular surgeries are significantly more complex with longer bypass and cross clamp times for type IV vEDS compared to nEDS patients. Reduced overall survival underscores the complexity and fragility of vEDS patients.

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“…One such example is the implanted frozen elephant trunk. However, we need more long-term published data to support such an approach [19].…”

Section: Acute Aortic Dissectionmentioning

confidence: 99%

Thoracic endovascular aortic repair: Current evidence and challenges

Juraszek¹,

Czerny²,

Rylski³

2022

Kardiol Pol

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In 1987 Nikolay Volodos performed the world's first endovascular treatment of aortic aneurysms. Endovascular technology has progressed significantly since then. There are now many thoracic endovascular aortic repair (TEVAR) systems commercially available. By applying them, we can treat many pathologies: aneurysms, dissections, aortic ruptures, and penetrating aortic ulcers. However, TEVAR technology still has its limitations, namely the risk of a retrograde type A dissection, the issue of precise landing in the distal landing zone, and the risk of air embolism and paraplegia. Furthermore, there are no appropriate stent grafts widely available to treat acute dissections. Those currently used are designed for aneurysms, not for dissections. As a result, there are several challenges facing the future TEVAR surgical community, such as the need to develop new and more precise systems with retrograde deployment for the distal landing zone, as well as to introduce flexible stent grafts to treat dissections. The endo-Bentall is being developed as an alternative treatment method for acute type-A aortic dissection.

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The Role of Thoracic Endovascular Aortic Repair (TEVAR) of Thoracic Aortic Diseases in Patients with Connective Tissue Disorders – A Literature Review

Cited by 14 publications

References 62 publications

Endovascular Treatment of Aortic Pathologies in Patients With Marfan Syndrome: Single-Center Experience

Endovascular Treatment of Aortic Pathologies in Patients With Marfan Syndrome: Single-Center Experience

Early and Late Outcomes of Cardiovascular Surgery in Patients With Ehlers-Danlos Syndrome

Thoracic endovascular aortic repair: Current evidence and challenges

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