Endovascular repair of ascending aortic dissection

Pontes, José Carlos Dorsa Vieira; Dias, Amaury Mont'Serrat Ávila Souza; Duarte, João Jackson; Benfatti, Ricardo Adala; Gardenal, Neimar

doi:10.5935/1678-9741.20130018

Cited by 9 publications

(4 citation statements)

References 4 publications

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“…Blood pressure and cardiac output were reportedly decreased by ventricular tachycardia when the delivery system contacted the left ventricular wall, which was beneficial for rapid and accurate stent release. 17 In this study, the anterior vertebra of the tip set of the delivery system entered the left ventricle through the aortic valve but did not touch the left ventricular wall; therefore, ventricular tachycardia was not induced.…”

Section: Discussionmentioning

confidence: 77%

Application of an extracorporeal prefenestrated stent graft in endovascular repair of ascending aorta and aortic arch lesions

et al. 2020

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Objectives Aortic dissection involving the ascending aorta and aortic arch is a serious condition. Treatment using traditional surgical methods has certain disadvantages. This study investigated the effectiveness of thoracic endovascular repair of aortic dissection using an external prefenestrated stent. Methods We present a series of aortic dissection cases involving the ascending aorta and aortic arch treated with an external prefenestrated stent. Results Postoperative follow-up of the patients showed that all stents were released at the proper position and that branch vessels were not occluded, and there were no instances of type I endoleak. One patient died suddenly one week after surgery; another experienced retrograde type A aortic dissection in the second week; and type I endoleak occurred in one patient in the first week, although this resolved within six months. No serious complications such as cerebrovascular events, acute spinal cord ischemia, and paraplegia occurred during the perioperative period. All patients had false lumen thrombosis in the ascending aorta and aortic arch. Conclusion Prefenestrated stent grafting is a feasible treatment option for repairing an entry tear in the ascending aorta.

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Section: Discussionmentioning

confidence: 77%

Application of an extracorporeal prefenestrated stent graft in endovascular repair of ascending aorta and aortic arch lesions

et al. 2020

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“…At the completion of the review, 31 studies were included (19 case reports and 12 case series), describing a total of 92 patients who underwent ascending aortic endovascular repair for TAAD (Figure 1). 13,22‐51 The selected studies were published between 2000 and 2019.…”

Section: Resultsmentioning

confidence: 99%

Endovascular ascending aortic repair in type A dissection: A systematic review

et al. 2020

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Purpose: Up to 10% of acute type A aortic dissection (TAAD) patients are deemed unfit for open surgical repair, exposing these patients to high mortality rates. In recent years, thoracic endovascular aortic repair has proven to be a promising alternative treatment modality in specific cases. This study presents a comprehensive overview of the current state of catheter-based interventions in the setting of primary TAAD. Methods: A literature search was conducted, using MEDLINE and PubMed databases according to PRISMA guidelines, updated until January 2020. Articles were selected if they reported on the endovascular repair of DeBakey Type I and II aortic dissections. The exclusion criteria were retrograde type A dissection, hybrid procedures, and combined outcome reporting of mixed aortic pathologies (e.g., pseudoaneurysm and intramural hematoma). Results: A total of 31 articles, out of which 19 were case reports and 12 case series, describing a total of 92 patients, were included. The median follow-up was 6 months for case reports and the average follow-up was 14 months for case series. Overall technical success was 95.6% and 30-day mortality of 9%. Stroke and early endoleak rates were 6% and 18%, respectively. Reintervention was required in 14 patients (15%). Conclusion: This review not only demonstrates that endovascular repair in the setting of isolated TAAD is feasible with acceptable outcomes at short-term follow-up, but also underlines a lack of mid-late outcomes and reporting consistency. Studies with longer follow-up and careful consideration of patient selection are required before endovascular interventions can be widely introduced.

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“…33 The use of endovascular repair for such a complex disease is still in its infancy. 42,43 The future in this area is exciting because both endovascular repair and stenting have revolutionised the management of type B aortic dissection and aortic valve disease in patients of advanced age by the evolution of transcatheter-based aortic valve implantation. Despite the current evidence of successful use of endovascular repair for ATAAD, surgical repair will remain the gold standard approach for both acute and chronic TAAD until the long-term outcomes of endovascular repair can be proven durable and comparable with those of open repair and until a randomised controlled study of endovascular and open surgical repair in the two subgroups can be performed.…”

Section: Risk Stratificationmentioning

confidence: 99%

The future of stenting in patients with type A aortic dissection: a systematic review

2019

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Acute type A aortic dissection (ATAAD) carries high morbidity and mortality rates and is a clinical emergency. The reported mortality rate is 50% to 65% within the first 48 hours without surgical intervention. Open surgery therefore remains the gold standard management for ATAAD. However, in patients who are deemed unfit for surgery and where possible, endovascular repair offers a useful alternative to medical treatment alone or high-risk open surgical repair. Several case reports, case series, and retrospective studies have reported good outcomes following endovascular treatment. The endovascular option also has comparable early and late outcomes, favourable aortic remodelling, and satisfactory overall survival despite having a higherrisk patient cohort. However, stenting in patients with ATAAD undoubtedly still has several limitations and technical challenges.

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Endovascular repair of ascending aortic dissection

Cited by 9 publications

References 4 publications

Application of an extracorporeal prefenestrated stent graft in endovascular repair of ascending aorta and aortic arch lesions

Application of an extracorporeal prefenestrated stent graft in endovascular repair of ascending aorta and aortic arch lesions

Endovascular ascending aortic repair in type A dissection: A systematic review

The future of stenting in patients with type A aortic dissection: a systematic review

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