Impact of endoluminal stenting for aortic surgery

Abstract

SummaryThe advent of stents has profoundly changed percutaneous transluminal coronary angioplasty (PTCA), peripheral transluminal artery angioplasty (PTA), and treatment strategies of numerous other problems. Similar developments can be observed for stent applications in peripheral vascular lesions, cerebro-vascular disease, and many other fields. With the advent of covered stent-grafts, aneurysm surgery, has been put up for competitive treatment approaches. Such new approaches are perceived as less invasive, and draw significant attention. Endovsacular aneurysm repair (EVAR) is here to stay. In addition new developments are coming in many ways and stent derived devices can by now be found everywhere in the cardio-vascular system. This includes stenosed vessels, aneurysmal vessels, diseased valves, all sorts of congenital heart defects, and even cardiopulmonary bypass. Impact in the pastThe advent of stents has profoundly changed percutaneous transluminal coronary angioplasty (PTCA), peripheral transluminal artery angioplasty (PTA), and treatment strategies of numerous other problems.As a matter of fact, stent-based treatments of coronary artery stenoses are by now in many countries far more frequent than the formerly so successful coronary artery bypass graft (CABG) procedures. This development has occurred despite the fact, that traditional left internal thoracic artery to the left anterior descending coronary artery implants have the best long-term patency, and that coronary artery bypass graft (CABG) procedures provide superior long-term outcome with less adverse events. In addition, off-pump coronary artery bypass (OPCAB) allowing for elimination of pump related events, did not substantially change the increased use of the even lesser invasive stentbased treatments strategies.Similar developments can be observed for stent applications in peripheral vascular lesions, cerebro-vascular lesions, tracheo-bronchial lesions, hepato-biliary and pancreatic problems, as well as genito-urinary affections. In addition, a number of stent-derived treatment modalities are proposed, and used in increasing proportions for closure of the patent ductus arteriosus, foramen ovale, atrial septal defects, ventricular septal defects, etc. Despite non-negligible complication rates and incomplete treatments, percutaneous procedures are overall far more popular among both, doctors and patients.With the advent of covered stent-grafts, yet another field of cardio-vascular surgery, namely aneurysm surgery, has been put up for competitive treatment approaches, and once again, the new approach is perceived as less invasive, and draws significant attention. Impact in generalThoracic aortic aneurysm and thoracic aortic dissection repair has traditionally been an almost exclusive domain of cardiac and cardio-vascular surgery. However, this activity based on open surgery with and without adjuncts (cardiopulmonary bypass, deep hypothermic circulatory arrest, left heart bypass, selective perfusion, etc.) is more and more under attack by (non-)...

Changes in Coronary Flow Reserve following Stent Implantation in the Swine Descending Thoracic Aorta

“…[1][2][3][4] Aortic stenting can be applied to many patients ineligible for surgery, and it could be a preferred alternative to surgery under certain conditions. [5][6][7] However, the deployment of an endovascular device, as well as its incorporation in the vessel wall, is bound to confer changes in wall mechanics.…”