Editor's Choice – Management of Descending Thoracic Aorta Diseases

Riambau, Vicente; Böckler, Dittmar; Brunkwall, Jan; Cao, Piergiorgio; Chiesa, Roberto; Coppi, Gilberto; Czerny, Martin; Fraedrich, Gustav; Haulon, Stéphan; Jacobs, Michael J.; Lachat, Mario; Moll, Frans L.; Setacci, Carlo; Taylor, Peter R.; Thompson, Matt; Trimarchi, Santi; Verhagen, Hence J.M.; Verhoeven, Eric L.G.; Kolh, Philippe; Borst, Gert J. de; Chakfé, Nabil; Debus, Eike Sebastian; Hinchliffe, R.J.; Kakkos, Stavros K.; Končar, Igor; Lindholt, Jes Sanddal; Céniga, Melina Vega de; Vermassen, Frank; Verzini, Fabio; Black, James H.; Busund, Rolf; Björck, Martin; Dake, Michael D.; Dick, Florian; Eggebrecht, Holger; Evangelista, Arturo; Grabenwöger, Martin; Milner, Ross; Naylor, A.R.; Ricco, Jean‐Baptiste; Rousseau, Hervé; Schmidli, Jürg

doi:10.1016/j.ejvs.2016.06.005

Cited by 841 publications

(210 citation statements)

References 300 publications

Supporting

Mentioning

196

Contrasting

Unclassified

Order By: Relevance

“…Patients with a distal-landing zone of less than 15-mm length and a proximal neck diameter of >40 mm are unsuitable for treatment with currently available devices [35].…”

Section: Case 4 (Figure 5): a 26-year-old Female Bd Patient Presents mentioning

confidence: 99%

“…Although several imaging techniques are available, such as MRI, positron emission tomography (PET), digital subtraction angiography, and intravascular ultrasonography, CTA scan is currently the gold standard for aortic imaging; it allows a conclusive study of thoracic aorta, showing an increased size of thoracic or thoracoabdominal aorta, and it can distinguish different aortic diseases like acute aortic syndromes (AASs) with a sensitivity up to 100% [18,35].…”

Section: Descending Thoracic and Thoracoabdominal Aortic Aneurysmmentioning

confidence: 99%

“…Open surgical repair should be reserved to patients unsuitable for thoracic endovascular aortic repair (TEVAR) in patients affected from DTAA, while remaining the recommended treatment of choice for patients affected from TAAA [35].…”

Section: Open Repairmentioning

confidence: 99%

“…AASs are defined as lesions involving disruption of the media of the aorta, with blood flow between the layers of the vessel or transmurally in the case of rupture [35].…”

Section: Descending Thoracic and Thoracoabdominal Aortic Aneurysmmentioning

confidence: 99%

“…SCI is due to reperfusion injury to the spinal cord caused by the sudden interruption of blood flow and its subsequent restoration. Methods like somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs) are employed to monitor the spinal cord function; cerebrospinal fluid drainage, left heart bypass, and cardiopulmonary extracorporeal circulation with induced systemic hypothermia reduce the risk of SCI [35].…”

Section: Descending Thoracic and Thoracoabdominal Aortic Aneurysmmentioning

confidence: 99%

See 4 more Smart Citations

Surgical Treatment of Angio‐Behçet

Genadiev¹,

Mortola²,

Arzedi³

et al. 2017

Behcet's Disease

View full text Add to dashboard Cite

Patients with Behçet's disease are at risk for multiple vessel-related complications including thromboses, stenoses, occlusions, and aneurysms. Surgical treatment of Angio-Behçet brings numerous challenges due to the peculiarities of the disease process and the high rate of complications. Recurrent vascular episodes are also quite common and Behçet patients require rigorous follow-up. In this review, we focus on the manifestations of Behçet's disease involving the venous system and the systemic arterial vasculitis focusing on the indications, workup, and techniques for surgical treatment. Several case studies from our own experience are presented together with supporting diagnostic imaging and the decision process whether to intervene is discussed. Although open surgery remains a valid option, new endovascular techniques are rapidly advancing and offer excellent results with important decrease in morbidity and mortality even in highly compromised patients.

show abstract

“…Patients with a distal-landing zone of less than 15-mm length and a proximal neck diameter of >40 mm are unsuitable for treatment with currently available devices [35].…”

Section: Case 4 (Figure 5): a 26-year-old Female Bd Patient Presents mentioning

confidence: 99%

Section: Descending Thoracic and Thoracoabdominal Aortic Aneurysmmentioning

confidence: 99%

Section: Open Repairmentioning

confidence: 99%

“…AASs are defined as lesions involving disruption of the media of the aorta, with blood flow between the layers of the vessel or transmurally in the case of rupture [35].…”

Section: Descending Thoracic and Thoracoabdominal Aortic Aneurysmmentioning

confidence: 99%

Section: Descending Thoracic and Thoracoabdominal Aortic Aneurysmmentioning

confidence: 99%

See 3 more Smart Citations

Surgical Treatment of Angio‐Behçet

Genadiev¹,

Mortola²,

Arzedi³

et al. 2017

Behcet's Disease

View full text Add to dashboard Cite

show abstract

Initial Thoracic Endovascular Aortic Repair vs Medical Therapy for Acute Uncomplicated Type B Aortic Dissection

et al. 2023

View full text Add to dashboard Cite

ImportanceThoracic endovascular aortic repair (TEVAR) has increasingly been used for uncomplicated type B aortic dissection (uTBAD) despite limited supporting data.ObjectiveTo assess whether initial TEVAR following uTBAD is associated with reduced mortality or morbidity compared with medical therapy alone.Design, Setting, and ParticipantsThis cohort study included Centers for Medicare &amp; Medicaid Services inpatient claims data for adults aged 65 years or older with index admissions for acute uTBAD from January 1, 2011, to December 31, 2018, with follow-up available through December 31, 2019.ExposuresInitial TEVAR was defined as TEVAR within 30 days of admission for acute uTBAD.Main Outcomes and MeasuresOutcomes included all-cause mortality, cardiovascular hospitalizations, aorta-related and repeated aorta-related hospitalizations, and aortic interventions associated with initial TEVAR vs medical therapy. Propensity score inverse probability weighting was used.ResultsOf 7105 patients with eligible index admissions for acute uTBAD, 1140 (16.0%) underwent initial TEVAR (623 [54.6%] female; median age, 74 years [IQR, 68-80 years]) and 5965 (84.0%) did not undergo TEVAR (3344 [56.1%] female; median age, 76 years [IQR, 69-83 years]). Receipt of TEVAR was associated with region (vs South; Midwest: adjusted odds ratio [aOR], 0.66 [95% CI, 0.53-0.81]; P &lt; .001; Northeast: aOR, 0.63 [95% CI, 0.50-0.79]; P &lt; .001), Medicaid dual eligibility (aOR, 0.76; 95% CI, 0.63-0.91; P = .003), hypertension (aOR, 1.26; 95% CI, 1.03-1.54; P = .03), peripheral vascular disease (aOR, 1.24; 95% CI, 1.02-1.49; P = .03), and year of admission (2012, 2013, 2014, and 2015 were associated with greater odds of TEVAR compared with 2011). After inverse probability weighting, mortality was similar for the 2 strategies up to 5 years (hazard ratio [HR], 0.95; 95% CI, 0.85-1.06), as were aorta-related hospitalizations (HR, 1.12; 95% CI, 0.99-1.27), aortic interventions (HR, 1.01; 95% CI, 0.84-1.20), and cardiovascular hospitalizations (HR, 1.05; 95% CI, 0.93-1.20). In a sensitivity analysis that included deaths within the first 30 days, initial TEVAR was associated with lower mortality over a period of 1 year (adjusted HR [aHR], 0.86; 95% CI, 0.75-0.99; P = .03), 2 years (aHR, 0.85; 95% CI, 0.75-0.96; P = .008), and 5 years (aHR, 0.87; 95% CI, 0.80-0.96; P = .004).Conclusions and RelevanceIn this study, 16.0% of patients underwent initial TEVAR within 30 days of uTBAD, and receipt of initial TEVAR was associated with hypertension, peripheral vascular disease, region, Medicaid dual eligibility, and year of admission. Initial TEVAR was not associated with improved mortality or reduced hospitalizations or aortic interventions over a period of 5 years, but in a sensitivity analysis that included deaths within the first 30 days, initial TEVAR was associated with lower mortality. These findings, along with cost-effectiveness and quality of life, should be assessed in a prospective trial in the US population.

show abstract

Outcomes After Endovascular Aortic Intervention in Patients With Connective Tissue Disease

et al. 2023

View full text Add to dashboard Cite

ImportanceEndovascular treatment is not recommended for aortic pathologies in patients with connective tissue diseases (CTDs) other than in redo operations and as bridging procedures in emergencies. However, recent developments in endovascular technology may challenge this dogma.ObjectiveTo assess the midterm outcomes of endovascular aortic repair in patients with CTD.Design, Setting, and ParticipantsFor this descriptive retrospective study, data on demographics, interventions, and short-term and midterm outcomes were collected from 18 aortic centers in Europe, Asia, North America, and New Zealand. Patients with CTD who had undergone endovascular aortic repair from 2005 to 2020 were included. Data were analyzed from December 2021 to November 2022.ExposureAll principal endovascular aortic repairs, including redo surgery and complex repairs of the aortic arch and visceral aorta.Main Outcomes and MeasuresShort-term and midterm survival, rates of secondary procedures, and conversion to open repair.ResultsIn total, 171 patients were included: 142 with Marfan syndrome, 17 with Loeys-Dietz syndrome, and 12 with vascular Ehlers-Danlos syndrome (vEDS). Median (IQR) age was 49.9 years (37.9-59.0), and 107 patients (62.6%) were male. One hundred fifty-two (88.9%) were treated for aortic dissections and 19 (11.1%) for degenerative aneurysms. One hundred thirty-six patients (79.5%) had undergone open aortic surgery before the index endovascular repair. In 74 patients (43.3%), arch and/or visceral branches were included in the repair. Primary technical success was achieved in 168 patients (98.2%), and 30-day mortality was 2.9% (5 patients). Survival at 1 and 5 years was 96.2% and 80.6% for Marfan syndrome, 93.8% and 85.2% for Loeys-Dietz syndrome, and 75.0% and 43.8% for vEDS, respectively. After a median (IQR) follow-up of 4.7 years (1.9-9.2), 91 patients (53.2%) had undergone secondary procedures, of which 14 (8.2%) were open conversions.Conclusions and RelevanceThis study found that endovascular aortic interventions, including redo procedures and complex repairs of the aortic arch and visceral aorta, in patients with CTD had a high rate of early technical success, low perioperative mortality, and a midterm survival rate comparable with reports of open aortic surgery in patients with CTD. The rate of secondary procedures was high, but few patients required conversion to open repair. Improvements in devices and techniques, as well as ongoing follow-up, may result in endovascular treatment for patients with CTD being included in guideline recommendations.

show abstract

Editor's Choice – Management of Descending Thoracic Aorta Diseases

Abstract: General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available:

Cited by 841 publications

References 300 publications

Surgical Treatment of Angio‐Behçet

Surgical Treatment of Angio‐Behçet

Initial Thoracic Endovascular Aortic Repair vs Medical Therapy for Acute Uncomplicated Type B Aortic Dissection

Outcomes After Endovascular Aortic Intervention in Patients With Connective Tissue Disease

Contact Info

Product

Resources

About