Cardiac and Aortic Modifications After Endovascular Repair for Blunt Thoracic Aortic Injury: A Systematic Review

Comparison of Two Generations of Thoracic Aortic Stent Grafts and Their Impact on Aortic Stiffness in an Ex Vivo Porcine Model

“…Potential improvements in device design may reduce the impact of thoracic aortic stent grafts on aortic stiffness and prevent future cardiovascular events. 8 , 9 , 13 , 24 This may improve the long term outcomes of endovascular aortic treatment modalities by reducing a patient's cardiovascular risk. On the other hand, caution and lifelong surveillance remain crucial, as this may also negatively impact clinical outcomes or cause device failure.…”

“…Boxplots were created to summarise results graphically. Exclusion criteria were adopted: (1) a conservation time of more than 48 hours between harvesting of the aorta and the experiment; (2) aortic specimens with severe aortic leakage during continuous flow pressurisation; (3) initial technical issues that resulted in unstable pressure values during continuous and/or pulsatile pressurisation; (4) experiments with a decline in PWV after stent graft deployment were not considered for statistical analysis as the impact of a stent graft on aortic PWV can be zero at minimum from a theoretical biomechanical point of view; 8 , 9 , 19 , 20 , 21 , 22 (5) extreme PWV increase outliers (>Q3 + 3 ∗ interquartile range) after stent graft deployment. Data were analysed using Matlab version R2022b (Mathworks, Natick, MA, USA), Microsoft Excel (Microsoft, Redmond, WA, USA), and IBM SPSS Statistics versions 27 and 28 (SPSS Inc., Chicago, IL, USA).…”

“… 6 , 7 Moreover, TEVAR has been shown to alter cardiovascular haemodynamics by increasing aortic stiffness 8 and inducing cardiovascular remodelling over time. 9 , 10 Increased aortic stiffness, normally occurring with age 11 and quantified by aortic pulse wave velocity (PWV), 12 is acknowledged to have an important impact on cardiovascular health. 13 …”

Different connective tissue disorders lead to similar outcomes of aortic disease: Are we missing something?

“…Especially in a young patient group with few comorbidities and a long life-expectancy, with or without CTD, the importance of lifelong surveillance and longterm follow-up data after TEVAR seems important as TEVAR has been associated with cardiac and aortic remodeling over time, in young patients with blunt thoracic aortic injury. 10 The use of TEVAR in CTD remains limited given the paucity of available evidence consisting of small series. 11 Recent efforts to integrate the use of TEVAR in Marfan patients in a multistage aortic repair strategy have shown promising, by optimizing treatment protocols by eliminating factors that could cause aortic complications (e.g., excluding stent grafts with bare stents and barbs, proximal landing in a pre-existing graft, proximal undersizing (< 10%) in case of landing in the native aorta, distal undersizing in chronic dissections).…”

“…Caution towards the use of TEVAR in CTD patients seems reasonable given their fragile aortic tissue and likeliness to develop complications at follow‐up (e.g., endoleak, retrograde type A aortic dissection, and conversion to open surgical repair). Especially in a young patient group with few comorbidities and a long life‐expectancy, with or without CTD, the importance of lifelong surveillance and long‐term follow‐up data after TEVAR seems important as TEVAR has been associated with cardiac and aortic remodeling over time, in young patients with blunt thoracic aortic injury 10 …”