Endovascular treatment of thoracic aortic aneurysms with a short proximal landing zone using scalloped endografts

Abstract

Our midterm results show that custom-made scalloped TEVAR is an acceptable treatment of thoracic aortic aneurysms with a short proximal landing zone. Longer term outcome data are required to establish wider use of scalloped thoracic endografts.

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

“…In a single reported small series, the mortality rate was 5% and the stroke rate 14%. 197 Stroke remains a major concern in any kind of open or endovascular aortic arch treatment strategy and can be seen as the major important challenge to address in the years to come.…”

Various Endoluminal Approaches Available for Treating Pathologies of the Aortic Arch

“…In two small single-centre series, the incidence of stroke ranged from 0-14% and endoleak from 10-19%. There was no evidence of migration or branch occlusion [15,16]. of follow-up with an 8% late reintervention rate to treat two cases of type 1a and one case of type 2 endoleaks.…”

“…Activated clotting time (ACT) should be performed in theatre. ACT target of > 250 is considered an accepted marker for patient’s anti thrombotic status 10 Assessment and patency of circle of willis prior to endoluminal intervention is advisable Important numbers in endoluminal techniques Proximal landing zone length 20 mm Native aortic diameter < 38 mm Arch angulation > 60° Access vessel for the main device > 7 mm Ascending aortic length (from sinotubular junction to origin of innominate) > 45 mm Important studies Haulon S et al 2014 [ 15 ] Global experience with an inner branched arch endograft. J Thorac Cardiovasc Surg .…”

Proximal scalloped custom-made Relay® stent graft in chronic type B dissection: endovascular repair in a drug abuser patient

“…2). Technical procedural challenges included the advancement of the delivery system through the narrowed true lumen and the proper alignment of the scallop matching to the ostium of the left common carotid artery [3]. Both aspects were managed successfully due to the fl exibility and smoothness of the inner sheath in the delivery device and the auto-alignment capability and accurate positioning of the stent-graft due to its precurved internal design.…”