Endovascular Repair of the Thoracic Aorta: Lessons Learned

MDCT of endoleaks following endovascular repair of abdominal aortic aneurysms

“…A third subclasification (Type Ic) denotes the rare instance when there is retrograde filling of an aneurysm in a patient who underwent simultaneous EVAR and femoral-femoral bypass with occlusion of the contralateral femoral artery; retrograde flow into the aneurysm sac occurs because of incomplete occlusion of the femoral artery. Types Ia and Ib endoleaks are most common in patients with atypical arterial anatomy (tortuosity, peripheral thrombus) and after EVAR of a thoracic aortic aneurysm [30]. An MDCT finding that is suggestive of a type I endoleak is the presence of abnormal enhancement that abuts or communicates with the proximal or distal attachment sites (Fig.…”

The Vienna aneurysm program

“…Furthermore, no alloplastic material has to be used. Other groups have proposed extraanatomical, extrathoracic rerouting procedures using carotideo-carotideal retropharyngeal alloplastic bypass grafting with consecutive overstenting of the left subclavian artery in distal arch aneurysms having obtained favourable results [58,59]. However, smaller alloplastic grafts may be more prone to sustain early or late thrombosis than any kind of autologous or orthotopic rerouting.…”

Technical Challenges in Endovascular Repair of Complex Thoracic Aortic Aneurysms

“…The usefulness and low-invasiveness of TEVAR for thoracic descending aneurysms are apparent, but problems of TEVAR are concentrated in arch aneurysms 5,6) : placement in the curve and maintenance of branch blood flow. To deploy a stent graft in the arch, it is necessary to secure a landing zone as long as possible, for which we devised various methods.…”