A Review of the Endovascular Management of Thoracic Aortic Pathology

Bell, David R.; Bassin, Levi; Neale, Michael; Brady, Peter

doi:10.1016/j.hlc.2015.05.008

Cited by 9 publications

(7 citation statements)

References 16 publications

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“…5 Therefore, LSA becomes a key factor of consideration for TEVAR. 6 Reconstruction of the LSA ensures the blood flow in the vertebral artery after operation, and thus reduces the risk of cerebral infarction; meanwhile, it reduces the incidence of paraplegia and left limb ischemia symptoms. 7 Therefore, we believe that, in order to further ensure the safety of the procedure, reduce the occurrence of postoperative complications, and improve the quality of life of patients, careful imaging evaluation should be carried out in the perioperative period, and the LSA should be reconstructed by various technical means only if possible.…”

Section: Discussionmentioning

confidence: 99%

Hybrid versus in vitro fenestration for preserving the left subclavian artery in patients undergoing thoracic endovascular aortic repair with unfavorable proximal landing zone

et al. 2019

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Purpose To compare hybrid and in vitro fenestration procedures for preserving the left subclavian artery in thoracic endovascular aortic repair (TEVAR) with unfavorable proximal landing zone. Methods Retrospective comparison of data from 49 consecutive patients who underwent left subclavian artery revascularization during TEVAR by either hybrid or fenestration approaches from January 2015 to March 2018. Procedural duration, and 30-day rates of procedural success, mortality and complications (endoleaks, cerebral infarction, spinal cord ischemia, left arm ischemic symptoms, and delirium) were compared. Results For hybrid procedure ( n = 32) vs. fenestration ( n = 17) groups, which were age and gender matched: procedural success rate was 100%, with significantly longer procedural duration (248.4 ± 40.9 vs. 60.6 ± 16.8 min; t = –22.653, P = 0.000) and similar 30-day complication rate (18.8% vs. 11.8%; χ2 = 0.397, P = 0.529). At 12.7 ± 9.3 months’ follow-up, there were no cases of death, spinal cord ischemia, or other complications in either group. Conclusions In this retrospective, single-center comparison, both hybrid and in vitro fenestration approaches for reconstructing the left subclavian artery in TEVAR with unfavorable proximal landing zone appeared safe and effective, with shorter procedural duration for fenestration. Larger studies with longer term follow-up are warranted.

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Section: Discussionmentioning

confidence: 99%

Hybrid versus in vitro fenestration for preserving the left subclavian artery in patients undergoing thoracic endovascular aortic repair with unfavorable proximal landing zone

et al. 2019

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“…20 It is now recommended that where coverage of the left subclavian artery is necessary, anatomical bypass of the left subclavian artery should also be performed. 21 Outcome studies…”

Section: Frozen Elephant Trunk Techniquesmentioning

confidence: 99%

A review of endovascular treatment of thoracic aorta disease

Tan

Khoo

Chan

2018

annals

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Introduction The development of thoracic endovascular aortic repair has altered the approach and reduced the risk of treating the majority of descending thoracic aortic conditions. Primarily developed for the exclusion of thoracic aortic aneurysms, it is now used in place of open repair surgery for most descending thoracic aortic diseases, and has also been used to treat aortic arch diseases in selected cases. Methods A literature search was conducted of Medline and Embase databases from January 2007 to February 2017, using the key words ‘aortic disease’, ‘thoracic aorta’ and ‘endovascular repair’; 205 articles were identified, of which 25 studies were selected for review based on their relevance. Findings The key findings of the indications, techniques, outcomes, complications and comparisons with open surgical repair were extracted from the published studies and are summarised in this review. Thoracic endovascular aortic repair is the preferred choice of intervention for patients with descending thoracic aortic disease. With time, it has improved to be safer and has the potential to expand aortic treatment choices in future.

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“…Introduction and development of the endovascular management of these disorders in the 1990s made it possible to treat descending thoracic aortic disease in subgroups of patients with too much risk for conventional open surgery (45), due to advanced age, associated pulmonary, renal and other complications. Since then, many published series have suggested significant clinical benefits, improved quality of life, fewer complications and increased survival among patients in which a thoracic endovascular aneurysm repair (TEVAR) has been performed for both acute (46)(47)(48)(49) and chronic elective thoracic aortic disease (3). In a nonrandomized, prospective controlled study, Patel et al (3) found that the elective endovascular treatment of 21 asymptomatic patients with chronic disease of the descending aorta and a high surgical risk because of advanced age (≥80 years) and/or significant comorbidities, with an indication for surgical repair, obtained survival benefits over the middle term compared with the medical treatment of 22 patients not amenable to TEVAR due to anatomical factors or that voluntarily didn't give informed consent for the operation.…”

Section: Acute Aortic Syndromes Of the Descending Thoracic Aortamentioning

confidence: 99%