Endovascular treatment of the dissected proximal aortic arch: a systematic review

Abstract

OBJECTIVES Surgical repair of aortic dissection involving the proximal aortic arch is associated with higher morbidity and mortality, in particular when elderly high-risk patients are concerned. Endovascular treatments for this disease are under evaluation and some reports exist. We investigated the current use of catheter-based treatments for the dissected proximal aortic arch repair. METHODS We searched in PubMed and MEDLINE databases up to the end of June 2020 for studies on endovascular treatment of the dissected proximal aortic arch. Data on demographic, procedure and stent graft (SG) details, access route, mortality with cause of death, complications and follow-up were extracted. A systematic review on the employed technology, procedure and outcome was performed. RESULTS A total number of 15 articles (13 retrospective reports and 2 case reports) were deemed eligible and were included in the study. In total, 140 patients (mean age: 56.7 years in 106 cases) received endovascular treatments for the dissected proximal aortic arch (unspecific aortic dissection: 14; acute and subacute type A aortic dissection: 88; chronic type A aortic dissection: 23; type B aortic dissection with retrograde type A dissection: 15). The procedure strategy included unspecific thoracic endovascular aorta repair (TEVAR) (n = 8), TEVAR + supra-aortic debranching (n = 2), TEVAR + cervical bypass (n = 8), TEVAR + periscope SG (n = 12), TEVAR + chimney graft (n = 8), TEVAR + branched SG (n = 21) and TEVAR + fenestration (n = 81). Procedural success rate was 95.6% for 116 reported cases. Complications included endoleaks (postoperative: 2; late: 5), stroke (n = 4), late SG-induced new entry (n = 3) and new false lumen formation (n = 1). Hospital mortality was 5% (6 cases) in 13 reports (120 patients). The mean follow-up time was 26.2 ± 29.4 months and 2 patients died during follow-up. CONCLUSIONS As an alternative to surgery for high-risk patients with a dissected proximal aortic arch, the endovascular treatment seems to be promising in highly selected cases. Further studies with long-term results and specifically designed devices are required to standardize this approach.

A canine model of aortic arch aneurysm created with autologous pericardium

“… 4 Total endovascular techniques in the aortic arch include the fenestrated stent graft, branched stent graft, and chimney technique. 6 , 7 , 8 , 9 , 10 , 11 Fenestrated stent grafts and branched stent grafts are complex and not widely available. 12 With regard to the chimney technique, the risk of a type Ia endoleak from the gutters between the main aortic graft and the chimney graft is much higher than that of other techniques.…”

Changes in Clinical Characteristics and Outcomes of Patients Admitted to Inpatient Cardiac Rehabilitation

“…In our center, located in Northeastern Italy, referrals are for post-surgical patients, who represent the core business and interest of the local (regional) stakeholders. Across the 13 years studied, older patients with more comorbidities were referred for surgery, since medical care has improved [21] and minimally invasive techniques are more frequently used in younger patients at a higher risk [22]. Nonetheless, comorbidities in chronic and disabled individuals do not preclude access to rehabilitation and its benefits [23].…”

Hotspots and development frontiers of postoperative complications of AD: Bibliometric analysis – a review

“…[14] Type B dissections are often treated using TEVAR. Although less invasive and having a shorter time frame, postoperative complications such as endoleaks, [15] secondary type A dissection, [16] stroke, [17] and paraplegia [18] can still occur. Further, AD results in different complications for different patient groups, such as the elderly, children, and pregnant women.…”

“…Figure6shows the top 20 authors' published papers over time. Coselli had the highest number of publications(17) during the considered period. His first publication on the subject was in 1991, and his greatest scientific production was registered in 2008.…”