Thoracic endovascular aortic repair: Current evidence and challenges

Abstract

In 1987 Nikolay Volodos performed the world's first endovascular treatment of aortic aneurysms. Endovascular technology has progressed significantly since then. There are now many thoracic endovascular aortic repair (TEVAR) systems commercially available. By applying them, we can treat many pathologies: aneurysms, dissections, aortic ruptures, and penetrating aortic ulcers. However, TEVAR technology still has its limitations, namely the risk of a retrograde type A dissection, the issue of precise landing in the distal landing zone, and the risk of air embolism and paraplegia. Furthermore, there are no appropriate stent grafts widely available to treat acute dissections. Those currently used are designed for aneurysms, not for dissections. As a result, there are several challenges facing the future TEVAR surgical community, such as the need to develop new and more precise systems with retrograde deployment for the distal landing zone, as well as to introduce flexible stent grafts to treat dissections. The endo-Bentall is being developed as an alternative treatment method for acute type-A aortic dissection.

Hospital Incidence, Sex Disparities, and Perioperative Mortality in Open Surgically Treated Patients with Aneurysms of the Ascending Aorta and Aortic Arch in Switzerland

“…The aortic root and the ascending aorta constitute unique anatomical and physiological characteristics. The rapid blood flow, the high wall tension, the proximity to the aortic valve and coronary ostia, as well as the four-dimensional pulsatile motion during cardiac and respiratory cycles, represent the ultimate challenges to endovascular therapy [45]. Despite these challenges, attempts to treat the ascending aorta endovascularly have been made since 2000 and have gained increasing attention as an alternative treatment strategy, especially for critically ill patients [41].…”

Deep learning-based diagnosis of aortic dissection using an electrocardiogram: Development, validation, and clinical implications of the AADE score

“…The confirmation of AD was based on the following criteria: CTA showed the presence of an intimal flap separating true and false lumens in the aorta, or there was an intramural hematoma; it involved the ascending aorta (defined as type A), the aortic arch, or descending aorta (type B). In our study, penetrating atherosclerotic ulcers and intramural hematomas were defined as AD, as they are similar in treatment and prognosis to typical AD [21]. This study was approved by the Review Committee of Tongji Hospital, affiliated with Tongji Medical College of Huazhong University of Science and Technology (TJ-IRB20230647).…”