Mid-Term Results of Endovascular Treatment for Descending Thoracic Aorta Diseases in High-Surgical Risk Patients

Examination of factors in type I endoleak development after thoracic endovascular repair

“…Different predictors of endoleak have been analyzed in the literature, 5,6,8,9,[20][21][22] including male gender, larger aneurysm size, length of aorta covered by the stent graft, number of stents used, proximal landing zone, and aortic arch morphology. The predictive value of a number of these factors is still controversial, notably aorta length covered by stent graft, considered protective of proximal endoleak by Verhoye et al 9 and, on the contrary, predictive of endoleak by Parmer et al and Morales et al 21,22 In all these studies, results were based only on univariable analysis.…”

“…Whereas studies reporting the incidence of endoleak after thoracic endovascular aortic repair (TEVAR) [3][4][5][6][7][8][9] include data of both emergently and electively treated patients, the impact of an emergency indication on endoleak occurrence has not yet been extensively analyzed. This study aimed to investigate the effect of the emergency setting on occurrence of persistent or new developing type I endoleak and to analyze the role played by different morphologic and stent graft-related factors as potential determinants of endoleak.…”

Combined Frozen Elephant Trunk and Endovascular Repair for Extensive Thoracic Aortic Aneurysms

“…As many as 40% of non-returning patients may die of aortic rupture [1]. We believe that the deployment of endoprostheses from distal to proximal may help to minimize the risk of type III endoleaks [9], which may hinder the durability of the aortic repair [10]. According to this strategy, the juxtaposition of contiguous endoprostheses is not exposed to antegrade blood flow and therefore to dynamic pressure; static pressure only applies.…”

Advances in thoracic aortic surgery: Arch replacement with axillary cannulation and thoracic stent grafts

“…Paraplegia is reported to occur in up to 5% of patients, with increasing risks with extensive stenting of the descending aorta, including the distal one-third, especially when coverage of the left subclavian artery cannot be avoided or in the absence of a patent internal iliac artery circulation (29). Midterm results appear to be related more to the patient's comorbidities than to aortic-related problems (30). The presence of an unresolved type 1 endoleak at follow-up portends a poor outcome, thus mandating a regular imaging follow-up (31).…”

“…The presence of an unresolved type 1 endoleak at follow-up portends a poor outcome, thus mandating a regular imaging follow-up (31). Additional stent-graft procedures are required in 10% to 15% of cases and seem to increase with time, thus mandating lifelong surveillance (30). Complex hybrid procedures, including extra-anatomical revascularization of visceral arteries followed by extensive stent grafting, have been reported by the authors (32) and others (33).…”