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Stenting of the Descending Aorta

  • A. D. Godfrey
  • N. J. Cheshire
  • C. D. BicknellEmail author
Chapter

Abstract

Endovascular repair of the thoracic aortic aneurysms (TEVAR) has broadened the available therapeutic options, allowing more patients to be definitively managed than was previously possible. This minimally invasive approach avoids thoracotomy and cross-clamp of the descending aorta with left heart bypass, and hence recovery is shorter, and short-term outcomes are improved. As technology has advanced, the number of patients that are anatomically suitable to be treated in this way has increased significantly.

In the course of this chapter, we explore key issues in planning, placement of the stent and strategies to avoid complications from TEVAR. Avoiding potential complications through a better understanding of the pathology and the treatment is key to good outcomes.

Keywords

Thoracic endovascular aortic repair TEVAR Stent graft Descending aorta Thoracic aortic aneurysm (TAA) Type B dissection 

References

  1. 1.
    Olsson C, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation. 2006;114:2611–8.CrossRefGoogle Scholar
  2. 2.
    von Allmen RS, Anjum A, Powell JT. Incidence of descending aortic pathology and evaluation of the impact of thoracic endovascular aortic repair: a population-based study in England and Wales from 1999 to 2010. Eur J Vasc Endovasc Surg. 2013;45:154–9.CrossRefGoogle Scholar
  3. 3.
    Hultgren R, et al. Female and elderly abdominal aortic aneurysm patients more commonly have concurrent thoracic aortic aneurysm. Ann Vasc Surg. 2012;26:918–23.CrossRefGoogle Scholar
  4. 4.
    Dake MD, et al. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med. 1994;331:1729–34.CrossRefGoogle Scholar
  5. 5.
    Eggebrecht H, et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J. 2006;27:489–98.CrossRefGoogle Scholar
  6. 6.
    Fattori R, et al. Complicated acute type B dissection: is surgery still the best option? A report from the International Registry of Acute Aortic Dissection. JACC Cardiovasc Interv. 2008;1:395–402.CrossRefGoogle Scholar
  7. 7.
    Shah AA, et al. Results of thoracic endovascular aortic repair 6 years after United States Food and Drug Administration approval. Ann Thorac Surg. 2012;94:1394–9.CrossRefGoogle Scholar
  8. 8.
    Goodney PP, et al. Survival after open versus endovascular thoracic aortic aneurysm repair in an observational study of the Medicare population. Circulation. 2011;124:2661–9.CrossRefGoogle Scholar
  9. 9.
    Patterson B, et al. Aortic pathology determines midterm outcome after endovascular repair of the thoracic aorta: report from the Medtronic thoracic Endovascular Registry (MOTHER) database. Circulation. 2013;127:24–32.CrossRefGoogle Scholar
  10. 10.
    Rudarakanchana N, et al. Variation in maximum diameter measurements of descending thoracic aortic aneurysms using unformatted planes versus images corrected to aortic centerline. Eur J Vasc Endovasc Surg. 2014;47:19–26.CrossRefGoogle Scholar
  11. 11.
    Balm R, Reekers JA, Jacobs MJ. Classification of endovascular procedures for treating thoracic aortic aneurysms. In: Jacobs MJ, Branchereau A, editors. Surgical and endovascular treatment of aortic aneurysms. New York: Futura Publishing Company; 2000. p. 19–26.Google Scholar
  12. 12.
    Lee WA, et al. Late outcomes of a single-center experience of 400 consecutive thoracic endovascular aortic repairs. Circulation. 2011;123:2938–45.CrossRefGoogle Scholar
  13. 13.
    Alsafi A, et al. Endovascular treatment of thoracic aortic aneurysms with a short proximal landing zone using scalloped endografts. J Vasc Surg. 2014;60:1499–506.CrossRefGoogle Scholar
  14. 14.
    Riga CV, et al. In vitro fenestration of aortic stent-grafts: implications of puncture methods for in situ fenestration durability. J Endovasc Ther. 2013;20:536–43.CrossRefGoogle Scholar
  15. 15.
    Abu-Ghaida AM, et al. Broadening the applicability of endovascular aneurysm repair: the use of iliac conduits. J Vasc Surg. 2002;36:111–7.CrossRefGoogle Scholar
  16. 16.
    Kpodonu J, et al. “Cracking and paving”: a novel technique to deliver a thoracic endograft despite ilio-femoral occlusive disease. J Card Surg. 2009;24:188–90.CrossRefGoogle Scholar
  17. 17.
    Riambau V, et al. Spinal cord protection and related complications in endovascular management of B dissection: LSA revascularization and CSF drainage. Ann Cardiothorac Surg. 2014;3:336–8.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Cheshire N, Bicknell N. Thoracic endovascular aortic repair: the basics. J Thorac Cardiovasc Surg. 2013;145:S149–53.CrossRefGoogle Scholar
  19. 19.
    Bicknell CD, Powell JT. Thoracic aortic aneurysms. Br J Surg. 2013;100:850–2.CrossRefGoogle Scholar
  20. 20.
    Griepp EB, Luozzo GD, Schray D, et al. The anatomy of the spinal cord collateral circulation. Ann Cardiothorac Surg. 2012;1:350–7.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Wyss TR, et al. Rate and predictability of graft rupture after endovascular and open abdominal aortic aneurysm repair: data from the EVAR Trials. Ann Surg. 2010;252:805–12.CrossRefGoogle Scholar
  22. 22.
    Harris PL, Buth J. An update on the important findings from the EUROSTAR EVAR registry. Vascular. 2004;12:33–8.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • A. D. Godfrey
    • 1
  • N. J. Cheshire
    • 1
  • C. D. Bicknell
    • 1
    Email author
  1. 1.Department of Surgery and CancerImperial College LondonLondonUK

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