Thoracic Aortic Frontier: Review of Current Applications and Directions of Thoracic Endovascular Aortic Repair (TEVAR)

Appoo, Jehangir J.; Tse, Leonard W.; Pozeg, Zlatko; Wong, Jason; Hutchison, Stuart J.; Gregory, Alex; Herget, Eric J.

doi:10.1016/j.cjca.2013.10.013

Cited by 34 publications

(21 citation statements)

References 66 publications

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“…Total arch replacement with median sternotomy is performed when an aneurysm is located in the arch or distal arch segment. If the descending aortic aneurysm is accompanied by an arch aneurysm, hybrid procedures (combined endovascular and vascular surgery procedures) are used [ 45 , 46 ]. Hybrid procedures include a staged approach and a simultaneous approach.…”

Section: Management and Treatmentmentioning

confidence: 99%

Management of acute aortic dissection and thoracic aortic rupture

Fukui¹

2018

j intensive care

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BackgroundBoth acute aortic dissection and ruptured aortic aneurysm are leading causes of death in cardiovascular disease. These life-threatening conditions have recently been categorized as acute aortic syndrome. This review describes the etiology, clinical presentation, and therapeutic options for acute aortic syndrome including acute aortic dissection and ruptured aortic aneurysm.Main bodySeveral diagnostic tools for detecting these critical conditions have been developed including computed tomography, ultrasonography, magnetic resonance imaging, and laboratory tests. Early and accurate diagnosis is most important to determine appropriate treatment. Initial treatment for these conditions should be aimed at controlling pain and the hemodynamic state with further treatment based on the imaging diagnosis and hematological assessment. Surgical outcomes after acute aortic syndrome are improving gradually; however, mortality remains high. Recently, thoracic endovascular aortic repair has become an alternative technique to treat complicated type B aortic dissection. Rapid treatment after early diagnosis is essential to save patients’ lives.ConclusionsContinuous advances in imaging and treatment technologies are improving short- and long-term outcomes in patients with acute aortic syndrome. Knowledge and interest in intensive care medicine in this area are contributing to improved outcomes, and further research into this life-threatening disease will lead to improvements in diagnosis and management.

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Section: Management and Treatmentmentioning

confidence: 99%

Management of acute aortic dissection and thoracic aortic rupture

Fukui¹

2018

j intensive care

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“…The revascularization of side branches can be addressed by various endovascular maneuvers, including customized endografts, hybrid debranching, snorkel and/or chimney techniques, or fenestrations created ex vivo or in vivo during thoracic endovascular aortic repair (TEVAR) or endovascular aneurysm repair (EVAR). 1,2…”

Section: Introductionmentioning

confidence: 99%

Optimal In Situ Fenestration Technique With Laser Perforation and Balloon Dilation for Aortic Stent-Grafts

et al. 2021

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Purpose: To evaluate the response of various stent-grafts after laser fenestration and dilation with noncompliant balloons to determine the optimal therapeutic combination for this treatment technique. Materials and Methods: Five aortic stent-grafts were evaluated ex vivo: the Bolton RelayPlus, Jotec E-vita Thoracic 3G, Medtronic Valiant, Cook Zenith Alpha, and Vascutek Anaconda. Small holes were created using an excimer laser with the grafts submerged in saline. Five rows of 5 fenestrations were created, 4 holes in each row were dilated once with a 6-, 8-, 10-, or 12-mm-diameter noncompliant balloon to the specified nominal pressure (one hole served as the control). The saline solution from each stent-graft was collected and qualitatively analyzed for debris. The fenestrations were evaluated under light and scanning electron microscopes. The maximum diameter and area for each fenestration were measured. The direction and length of tears were assessed. Results: The fenestration was feasible and reproducible in all the stent-grafts. The mean area of fenestration ranged from 7.63±1.63 to 14.75±0.73 mm2 when using balloons of 6- and 8-mm diameter, respectively. The 10- and 12-mm-diameter balloons caused a significant increase in area, variability, and tearing. The Anaconda graft tended to tear in the weft direction, while the other devices tore in the warp direction when using the 10- and 12-mm-diameter balloons. Dilation of the RelayPlus and Anaconda grafts with 6- and 8-mm-diameter balloons provided minimal tearing and precise fenestrations. Melted fiber remnants were observed after filtration of the saline solution for all devices. Conclusion: Laser fenestration and dilation with noncompliant balloons is a relatively simple and reproducible option for revascularization in urgent, complex aortic endovascular repairs. In our model, large balloons (ie, >10 mm) increased the destruction and tearing of the fabric. The maximum dilation recommended is 6 to 8 mm to avoid significant tears. Development of stent-grafts or novel fabrics designed explicitly for fenestration is needed to reduce potential complications.

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“…The yearly number of abdominal area contouring operations has been rapidly rising as the increase between years 1997 and 2014 was 382 % in the U.S. 3 . A major reason for the abdominal contouring procedure is excess skin after massive weight loss or bariatric surgery 4 .…”

Section: Introductionmentioning

confidence: 99%