Complex aortic disease: Changes in perception, evaluation and management

Abstract

Complex aortic disease continues to have a high mortality and morbidity despite advances in medical and surgical treatment. Repair of thoracoabdominal aneurysms, treatment of patients with connective tissue disorders, and the approach to dissections of the ascending and descending aorta have evolved over time; however, the results of intervention in all but highly specialized centers remain poor. As vascular surgeons, our role must extend beyond that of the pure technician; we have been vested with the life-long care of these patients and, therefore, have a responsibility to the patient in addition the scientific community and society at large to create a strategy for management that serves all three interests justly. We will outline some of the changes in the conceptual approach that we consider important to the treatment of complex aortic disease.

Stent graft modification with mini-cuff reinforced fenestrations for urgent repair of thoracoabdominal aortic aneurysms

“…9 However, Ridberg reported alarming results in the community, with 30-day mortality of 19% for elective and 48% for urgent or emergent repair. 10 Modified fenestrated endografts can be used to incorporate the visceral arteries and treat patients who present with symptomatic or contained ruptured complex aortic aneurysms and do not have access to manufactured devices.…”

Toward an Entirely Endovascular World for Thoracoabdominal Aortic Disease: Myth or Reality?

“…Total endovascular repair of thoracoabdominal aortic disease depends on the assessment of specific morphological criteria, including landing zones, aortic internal lumen diameter, aortic tortuosity, visceral vessel orientation, and quality of access vessels. Computed tomographic angiography (CTA) of the aorta and branch vessels and three-dimensional reconstruction and postprocessing image manipulation software are essential tools when advanced endovascular techniques are being utilized [1]. Multiplanar reconstructions according to the center lumen line are essential for accurate evaluation and planning, including the assessment of proximal and distal landing zones, the relationship of the aneurysm to the aortic arch and supra-aortic vessels, the degree of aortic tortuosity, and the size and quality of the access vessels ( Fig.…”

Thoracoabdominal aortic aneurysm repair: current endovascular perspectives

“…If possible, staged repair has been shown to reduce the incidence of postoperative paraplegia, by allowing collateral pathways to the anterior spinal artery to mature during serial interventions 26,27. Computed tomographic angiography of the aorta and branch vessels with three-dimensional reconstruction and postprocessing image manipulation software are essential tools when advanced endovascular techniques are being utilized 28. True centerline measurements and multiplanar reconstructions are essential in the accurate evaluation and planning, including the evaluation of proximal and distal landing zones, the degree of aortic tortuosity, the relationship of the aneurysm to arch and visceral branch vessels, and the size and quality of the access vessels.…”