Emergency Stent-Graft Placement for Impending Rupture of the Descending Thoracic Aorta

Nesser, H. Joachim; Eggebrecht, Holger; Baumgart, Dietrich; Ebner, Christian; Gschwendtner, Manfred; Barkhausen, Jörg; Erbel, Raimund; Nienaber, Christoph

doi:10.1177/15266028020090s212

Cited by 14 publications

(10 citation statements)

References 15 publications

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“…Thus, covering the hematoma with a stent-graft could emerge as a first-line treatment. [46][47][48] Marfan's syndrome damages the arterial walls and predisposes to aortic dissection. Few cases of aortic stent-graft treatment have been reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Midterm Results of Aortic Diameter Outcomes After Thoracic Stent-Graft Implantation for Aortic Dissection: A Multicenter Study

Gaxotte

Thony

Rousseau

et al. 2006

Journal of Endovascular Therapy

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Section: Discussionmentioning

confidence: 99%

Midterm Results of Aortic Diameter Outcomes After Thoracic Stent-Graft Implantation for Aortic Dissection: A Multicenter Study

Gaxotte

Thony

Rousseau

et al. 2006

Journal of Endovascular Therapy

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“…41 Nowadays, for circumscript, localised aneurysm formation, either true or false aneurysms, and for chronic or in some situations for acute aortic dissection, percutaneous stent graft implantation has become an alternative option. [45][46][47][48][49] Despite the limited number of patients treated and the limited follow up time, this technique could even be used in emergency situations with high procedural and clinical success rates. 50 The prerequisite is close cooperation of cardiologists, radiologists, anaesthetists, and cardiovascular surgeons, because the optimal strategy has to be chosen.…”

Section: Surgical and Endovascular Managementmentioning

confidence: 99%

Aortic dimensions and the risk of dissection

Erbel

Eggebrecht²

2006

Heart

171

103

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T he aorta represents a complex organ system which begins in the aortic ring adjacent to the aortic root with the origin of the two major coronary arteries, and ends at the iliac bifurcation. The subdivision into seven segments seems to be clinically important-the aortic root, the ascending aorta, the ascending aortic arch, the vessel bearing arch, the aortic isthmus, and the thoracic descending and abdominal aorta. The aorta as an organ can be regarded as a biological ''windkessel'', storing kinetic energy during systole which is delivered during diastole in order to maintain a relative constant mean aortic pressure. In particular, a high diastolic blood pressure is important for the coronary perfusion.The size of the aorta decreases with distance from the aortic valve in a tapering fashion. The normal diameter of the ascending aorta has been defined as ,2.1 cm/m 2 and of the descending aorta as ,1.6 cm/m 2 .1 The normal diameter of the abdominal aorta is regarded to be less than 3.0 cm. The normal range has to be corrected for age and sex, as well as daily workload.The aortic wall consists of three layers: intima, media, and adventitia. The intima is thin, the media contains the elastic fibres and smooth muscle cells forming a spiral layer of tissue providing the strength of the aortic wall, and the adventitia provides the nutrition with the arterial and venous vasa vasorum. An inner vasa vasorum from the aortic lumen also seems to be present.2 A wall thickness of , 4 mm is regarded as normal. AGEING cDuring life the size of the aorta increases. The normal expansion rate is about 1-2 mm/year. It involves all segments which, during childhood and in young adulthood, result in an increase of the luminal diameter of the entire aorta (figs 1 and 2). 3 In adulthood the aortic size is related to exercise and workload. The ageing of the aorta is accompanied by a loss of compliance, and an increase of wall stiffness caused by structural changes including an increase in the collagen content and formation of intimal atherosclerosis with calcium deposits.1 4 5 As a result pulse pressure is enhanced and pulse wave velocity raised, decreasing the resulting organ perfusion, particularly the predominant diastolic myocardial perfusion.Aortic sclerosis is subdivided into four stages: c intimal thickening c atheroma formation c protruding plaques c intimal flap and/or thrombus formation.Aortic sclerosis risk factors are hypertension, hyperlipidaemia, diabetes mellitus, and smoking. A thickness up to 7 mm is regarded as the upper normal tolerance limit. 1The incidence of ruptured thoracic aneurysms in individuals aged 60-69 years is about 100 cases per 10 000, in those aged 70-79 years it is about 300/10 000, and in those aged 80-89 years the incidence is 550/10 000. 6 DEFINITIONSAn enlargement of the aortic diameter exceeding at least 50% of the normal range represents an ectasia, which results in aneurysm formation when the ectasia exceeds tolerance limits. 5There are different forms of aneurysms: c true aneurysm means enlarge...

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“…These pathologies include: intramural hematoma (26), penetrating atherosclerotic ulcer (27), traumatic aortic injury (28), mycotic aneurysm (29), and acute rupture (30).…”

Section: Clinical Resultsmentioning

confidence: 99%

Endovascular Stent‐Grafts for Thoracic Aortic Disease

Eggebrecht¹,

Baumgart²,

Herold³

et al. 2002

Materialwissenschaft Werkst

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Diseases of the descending thoracic aorta pose a significant therapeutic challenge. The standard therapy for thoracic aneurysms or dissection is open surgical repair with prosthetic graft replacement of the diseased segment, requiring major thoracotomy. Despite important advances in surgical techniques, mortality and morbidity rates remain high. Endovascular stent-graft placement which is performed via the femoral route provides an attractive treatment alternative for thoracic aortic diseases. Due to its minimal-invasive approach, endovascular repair is also applicable for patients with contraindication to major surgery. Early results are encouraging, documenting low mortality and complication rates. However, longterm results, particularly concerning the long-term durability of the endoprostheses, are lacking, so far. Results of prospective randomized trials that compare the outcomes of endovascular repair with those of standard therapy are required before a widespread use of stent-grafts can be recommended.Erkrankungen der thorakalen Aorta stellen eine therapeutische Herausforderung dar. Die traditionelle Behandlung von thorakalen Aortenaneurysmen oder ±dissektionen umfasst die offene Operation mit Resektion und prothetischem Ersatz des betroffenen Aortenabschnitts. Diese Eingriff sind umfangreich und erfordern eine Ero Èffnung des Brustkorbs mittels Thorakotomie. Trotz signifikanter Fortschritte in der Operationstechnik sind Mortalita Èt und Morbidita Èt solcher Eingriffe weiterhin hoch. Die endovaskula Ère Aortenstentimplantation, die minimal-invasiv u Èber einen femoralen Zugang durchgefu Èhrt wird, stellt eine attraktive Behandlungsalternative dar. Der minimal-invasive Charakter des endovaskula Èren Versorgung erlaubt auch eine Behandlung von Patienten mit Kontraindikation gegen einen offenen Eingriff. Die Akutergebnisse belegen eine geringe Rate an Komplikationen und perioperativer Sterblichkeit. Langzeitergebnisse, vor allem mit Hinblick auf die Materialhaltbarkeit, stehen jedoch zum gegenwa Èrtigen Zeitpunkt aus. Randomisierte, prospektive Vergleichsstudien zur traditionellen Behandlung von Aortenerkrankungen sind notwendig, bevor eine breitere Anwendung der endovaskula Èren Aortenstentimplantation empfohlen werden kann.

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Emergency Stent-Graft Placement for Impending Rupture of the Descending Thoracic Aorta

Cited by 14 publications

References 15 publications

Midterm Results of Aortic Diameter Outcomes After Thoracic Stent-Graft Implantation for Aortic Dissection: A Multicenter Study

Midterm Results of Aortic Diameter Outcomes After Thoracic Stent-Graft Implantation for Aortic Dissection: A Multicenter Study

Aortic dimensions and the risk of dissection

Endovascular Stent‐Grafts for Thoracic Aortic Disease

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