Thoracic Aortic Endografting in Patients With Connective Tissue Diseases

Geisbüsch, Philipp; Kotelis, Drosos; Tengg-Kobligk, Hendrik von; Hyhlik‐Dürr, A.; Allenberg, Jens-Rainer; Böckler, Dittmar

doi:10.1583/07-2286.1

Cited by 96 publications

(57 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…19 In patients with connective tissue disease, high rates of endoleaks and reinterventions after TEVAR are reported. 20 In this cohort of patients, where a certain wall weakness exists eo ipso, early structural wall alterations after TEVAR (i.e., within landing zones) may be especially unfavorable. Additionally, we hypothesize that if open repair after TEVAR becomes necessary during the first days after stent implantation, the weakened aortic wall may make a stable anastomosis difficult.…”

Section: Discussionmentioning

confidence: 92%

Early Histological Changes in the Porcine Aortic Media After Thoracic Stent-Graft Implantation

Scheumann

Heilmann²,

Beyersdorf³

et al. 2012

Journal of Endovascular Therapy

Self Cite

View full text Add to dashboard Cite

¤ ¤Purpose: To describe the histological findings in the aortic wall 5 days after thoracic endovascular aortic repair (TEVAR) in a porcine model. Methods: Two overlapping stent-grafts were implanted in each of 6 juvenile pigs, covering the entire descending thoracic aorta (DTA). On the 5 th postoperative day, tissue samples were taken from the DTA in each animal. Medial thickness and medial necrosis were quantified and compared to measurements from the aortas of 6 control animals. Results: Significant medial thinning was observed in stent-covered regions in the test animals. At the proximal landing zone, aortic wall thickness changed from 1387668 to 782674 mm within the covered aortic segment (p50.028); at the distal landing site, the wall thickness was 365667 mm within the stent and 501657 mm distally (p50.028). In the overlap zone, the aortic wall measured 5246122 vs. 1053677 mm in native controls (p50.004). Aortic thickness proximal to the graft did not differ from the proximal region of native aortas (1468696 vs. 1513680 mm, p50.423), but the aorta was significantly thinner distal to the stent (707638 vs. 815652 mm, p50.004). Laminar necrosis constituted 38%67% of the media in the proximal landing zone, 54%64% in the overlap zone, and 46%613% in the distal landing zone. Conclusion: In this porcine model, significant medial thinning and necrosis of the stented aorta was observed. The findings suggest an early phase of vulnerability of the aortic wall, before scarring and adaptive changes have strengthened the residual aorta.

show abstract

Section: Discussionmentioning

confidence: 92%

Early Histological Changes in the Porcine Aortic Media After Thoracic Stent-Graft Implantation

Scheumann

Heilmann²,

Beyersdorf³

et al. 2012

Journal of Endovascular Therapy

Self Cite

View full text Add to dashboard Cite

show abstract

“…Such techniques assume constant censoring, and also combine what can be a rather heterogenous patient cohort. Finally, while the majority of studies in the present review were performed at centers where there was no endovascular alternative, the preference of TEVAR as the first-line surgical treatment in some centers has relegated open surgery for those with connective tissue or extensive disease, and those unsuitable for endovascular intervention (33,35,49).…”

Section: Discussionmentioning

confidence: 99%

Open surgical repair for chronic type B aortic dissection: A systematic review

Tian

Silva

Wang

et al. 2015

Heart, Lung and Circulation

View full text Add to dashboard Cite

Background: The treatment of chronic type B aortic dissection (CBAD) remains complicated. Thoracic endovascular aortic repair (TEVAR) has supplanted open surgical repair (OSR) as the preferred surgical treatment for CBAD. Despite TEVAR's superior short-term results, much less is understood about its longterm outcomes. As much of the understanding of OSR originates from historical report, contemporary series, with modern surgical techniques and technologies, may present an alternative to TEVAR. The present systematic review will assess the short-and long-term outcomes of historic and contemporary series of OSR for CBAD.Methods: Electronic searches were performed using six databases from their inception to March 2014.Relevant studies with OSRs for chronic type B dissection were identified. Data were extracted by two independent reviewers and analyzed according to predefined clinical endpoints. Studies were sub-classified into the pre-endovascular (historic series) and endovascular era (contemporary series) depending on whether the majority of cases were performed after 1999.Results: Nineteen studies were identified for inclusion for quantitative analysis. Pooled short-term mortality was 11.1% overall, and 7.5% in the nine contemporary studies. Stroke, spinal cord ischemia, renal dysfunction, and reoperation for bleeding were 5.9%, 4.9%, 8.1%, and 8.1%, respectively, for the contemporary series. Absolute late reintervention was identified in 13.3% of patients overall, and in 11.3% of patients in the contemporary series. Aggregated survival at 1-, 3-, 5-, and 10-years of all patients were 82.1%, 74.1%, 66.3%, and 50.8%, respectively.Conclusions: OSR for chronic type B dissection in the contemporary era offers acceptable results.Management approaches should be considered carefully, taking into account both short-term and long-term complications. More research is required to clarify specific indications for OSR and TEVAR in chronic type B dissections.

show abstract

“…The connective tissue disorders (CTDs), such as Marfan syndrome, are recognized as a poor indication for TEVAR. [17][18][19] Furthermore, dynamic interactions between endograft and landing zone may play a role in development of a RTAD, especially in ''zone 0.'' A continuous motion resulting from its attachment to the beating heart is specific of the ascending aorta, including both radial expansion-contraction and wall translational motion.…”

Section: Discussionmentioning

confidence: 99%