Endoscopic placement of stents in aneurysms of the descending thoracic aorta

Progress of the treatment for extended aortic aneurysms; is the frozen elephant trunk technique the next standard in the treatment of complex aortic disease including the arch?☆

“…Along with the advent of transfemoral stentgrafts for the treatment of descending aortic aneurysms it became possible to securely anchor a stent-graft in an elephant trunk prosthesis previously placed during arch surgery [9]. Published series of endovascular completion after previous elephant trunk procedure are summarized in Table 2 [27][28][29][30]. Although this cohort is relatively small, the procedural results seem to be promising with a low risk for paraplegia.…”

Use of transesophageal echocardiography during implantation of aortic endoprosthesis (stent). Initial experience

“…Endoprostheses have been used so far in the treatment of aortic diseases located in the descending portion of the aorta (true aneurysms, traumatic pseudoaneurysms, penetrating ulcers, and, more recently, type B aortic dissections) [9][10][11][12][13] . Technical difficulties do not allow their use in the aortic arch and the ascending aorta, basically due to the aortic bending in these portions and the emergence of essential vessels that cannot be occluded, except for the involvement of the distal portion of the arch 12 .…”

“…Compared with these examinations, transesophageal echocardiography has the advantage of allowing mobilization at the bedside, therefore enabling continuous monitoring of interventionist or surgical procedures performed in the thoracic aorta and in the proximal part of the abdominal aorta 1,3,[5][6][7][8] . Recently, the appearance of self-expanding aortic endoprostheses (stents) has opened a new perspective in the therapeutical approach of selected cases of diseases of the descending thoracic aorta, particularly those with high surgical risk due to comorbidities [9][10][11][12][13] .…”

Diretrizes para o tratamento cirúrgico das doenças da aorta da Sociedade Brasileira de Cirurgia Cardiovascular

“…In a possible outcome, if it is necessary to repair the descending aorta, the free end of the graft can be directly anastomosed to the aortic wall or extended by means of an additional tube to a more distal segments using left thoracotomy. As a more simplified alternative it may be valid to implant the covered stent to treat the descending aorta by inserting it under direct visualization into the aortic arch under the CCA [43] (C).…”