Abstract
Diseases of the aorta include a wide spectrum of acute and chronic conditions ranging from aortic aneurysms and malformations to acute aortic syndromes (AAS), including acute aortic dissection (AD), intramural haematoma (IMH), penetrating aortic ulcer (PAU) and even traumatic aortic injury (TAI). Furthermore, pseudoaneurysm, atherosclerotic and inflammatory conditions can affect the aorta at any location. High risk for acute aortic syndrome and for congenital abnormalities including coarctation of the aorta is often associated with syndromic features and hereditary genetic underpinnings. Classic surgical strategies were for many years the gold standard to treat many aortic conditions; the last two decades, however, has seen the emergence of less traumatic endovascular management as an additional or alternative option to classic surgical strategies. In particular scenarios, endovascular management has already replaced open surgery, while the complexity of the underlying vascular disease, the comorbidity and the increasing age of patients render this cohort very special. Therefore, every patient with aortic disease should be discussed by a dedicated aortic team of specialists that normally consists of vascular interventionalists (cardiology or radiology) and surgeons (cardiac or cardiothoracic) and dedicated anaesthesiologists with the idea to offer the individually best approach to a complex problem: the team should at the same time cover screening for aortic disease and follow-up after surgery or intervention at a personal level.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, Eggebrecht H, et al. Authors/task force members. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases. Eur Heart J. 2015;36:2779.
Meszaros I, Morocz J, Szlavi J, Schmidt J, Tornoci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117:1271–8.
Clouse WD, Hallett JW Jr, Schaff HV, Spittell PC, Rowland CM, Ilstrup DM, et al. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc. 2004;79:176–80.
Mehta RH, et al. Chronobiological patterns of acute aortic dissection. Circulation. 2002;106:1110–5.
Landenhed M, et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study. J Am Heart Assoc. 2015;4:e001513.
Nienaber CA, Clough RE, Sakalihasan N, Suzuki T, Gibbs R, Mussa F, et al. Aortic dissection. Nat Rev Dis Primers. 2016;2:16071.
VIRTUE Registry Investigators. Mid-term outcomes and aortic remodelling after thoracic endovascular repair for acute, subacute, and chronic aortic dissection: the VIRTUE Registry. Eur J Vasc Endovasc Surg. 2014;48:363–71.
Trimarchi S, Eagle KA, Nienaber CA, et al. Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg. 2010;140:784–9.
Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med. 1999;340:1539–45.
Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med. 1999;340:1546–52.
Chiappini B, et al. Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients. Eur Heart J. 2005;26:180–6.
Trimarchi S, et al. Contemporary results of surgery in acute type A aortic dissection: the International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg. 2005;129:112–22.
Tang GH, et al. Surgery for acute type A aortic dissection in octogenarians is justified. J Thorac Cardiovasc Surg. 2013;145:S186–90.
Weigang E, Parker JA, Czerny M, Lonn L, Bonser RS, Carrel T, et al. Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation? Eur J Cardiothorac Surg. 2011;40:858–68.
Eggebrecht H, Thompson M, Rousseau H, Czerny M, Lönn L, Mehta RH, Erbel R, European Registry on Endovascular Aortic Repair Complications. Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications. Circulation. 2009;120:S276–81.
Midulla M, Renaud A, Martinelli T, Koussa M, Mounier-Vehier C, Prat A, Beregi JP. Endovascular fenestration in aortic dissection with acute malperfusion syndrome: immediate and late follow-up. J Thorac Cardiovasc Surg. 2011;142:66–72.
Nienaber CA, Sakalihasan N, Clough RE, Aboukoura M, Mancuso E, Yeh JS, et al. Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: ready for a broader application? J Thorac Cardiovasc Surg. 2017;153:S3–11.
Shrestha M, Martens A, Kruger H, Maeding I, Ius F, Fleissner F, Haverich A. Total aortic arch replacement with the elephant trunk technique: single-Centre 30-year results. Eur J Cardiothorac Surg. 2014;45:289–96.
Roselli EE, Rafael A, Soltesz EG, Canale L, Lytle BW. Simplified frozen elephant trunk repair for acute DeBakey type I dissection. J Thorac Cardiovasc Surg. 2013;145:S197–201.
Jakob H, Dohle DS, Piotrowski J, Benedik J, Thielmann M, Marggraf G, Erbel R, Tsagakis K. Six-year experience with a hybrid stent graft prosthesis for extensive thoracic aortic disease: an interim balance. Eur J Cardiothorac Surg. 2012;42:1018–25.
Cao P, De Rango P, Czerny M, Evangelista A, Fattori R, Nienaber C, Rousseau H, Schepens M. Systematic review of clinical outcomes in hybrid procedures for aortic arch dissections and other arch diseases. J Thorac Cardiovasc Surg. 2012;144:1286–300.
Eggebrecht H, Nienaber CA, Neuhäuser M, et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J. 2006;27:489–98.
Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol. 2013;61:1661–78.
Onitsuka S, Akashi H, Tayama K, Okazaki T, Ishihara K, Hiromatsu S, et al. Long-term outcome and prognostic predictors of medically treated acute type B aortic dissections. Ann Thorac Surg. 2004;78:1268–73.
Fattori R, Tsai TT, Myrmel T, Evangelista A, Cooper JV, Trimarchi S, 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.
Grabenwöger M, Alfonso F, Bachet J, Bonser R, Czerny M, Eggebrecht H, European Association for Cardio-Thoracic Surgery (EACTS); European Society of Cardiology (ESC); European Association of Percutaneous Cardiovascular Interventions (EAPCI), et al. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg. 2012;42:17–24.
Acosta S, Blomstrand D, Gottsater A. Epidemiology and long-term prognostic factors in acute type B aortic dissection. Ann Vasc Surg. 2007;21:415–22.
Brunkwall J, Kasprzak P, Verhoeven E, et al. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg. 2014;48:285–91.
NienaberCA RH, Eggebrecht H, Kische S, Fattori R, Rehders TC, et al. Randomized comparison of strategies for type B aortic dissection: the INvestigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial. Circulation. 2009;120:2519–28.
Nienaber CA, Kische S, Rousseau H, Eggebrecht H, Rehders TC, Kundt G, et al. INSTEAD-XL trial. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6:407–16.
Wolff KA, Herold CJ, Tempany CM, et al. Aortic dissection: atypical patterns seen at MR imaging. Radiology. 1991;181:489–95.
Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: part II: therapeutic management and follow-up. Circulation. 2003;108:772–8.
Evangelista A, et al. Acute intramural hematoma of the aorta: a mystery in evolution. Circulation. 2005;111:1063–70.
Evangelista A, Czerny M, Nienaber C, Schepens M, Rousseau H, Cao P, Moral S, Fattori R. Interdisciplinary expert consensus on management of type B intramural haematoma and penetrating aortic ulcer. Eur J Cardiothorac Surg. 2015;47:209–17.
Nathan DP, et al. Presentation, complications, and natural history of penetrating atherosclerotic ulcer disease. J Vasc Surg. 2012;55:10–5.
Robertson MM, et al. A double-blind controlled comparison of fluoxetine and lofepramine in major depressive illness. J Psychopharmacol. 1994;8:98–103.
Ganaha F, et al. Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis. Circulation. 2002;106:342–8.
Coady MA, Rizzo JA, Elefteriades JA. Pathologic variants of thoracic aortic dissections: penetrating atherosclerotic ulcers and intramural hematomas. Cardiol Clin. 1999;17:637–57.
Movsowitz HD, Lampert C, Jacobs LE, et al. Penetrating atherosclerotic aortic ulcers. Am Heart J. 1994;128:1210–7.
Richens D, Kotidis K, Neale M, et al. Rupture of the aorta following road traffic accidents in the United Kingdom 1992–1999: the results of the co-operative crash injury study. Eur J Cardiothorac Surg. 2003;23:143–8.
Kodali S, Jamieson WR, Leia-Stephens M, Miyagishima RT, Janusz MT, Tyers GF. Traumatic rupture of the thoracic aorta. A 20-year review: 1969–1989. Circulation. 1991;84:S40–6.
Hunt JP, Baker CC, Lentz CW, Rutledge RR, Oller DW, Flowe KM, et al. Thoracic aorta injuries: management and outcome of 144 patients. J Trauma. 1996;40:547–55.
Rousseau H, Soula P, Perreault P, et al. Delayed treatment of traumatic rupture of the thoracic aorta with endoluminal covered stent. Circulation. 1999;99:498–504.
Scheinert D, Krankenberg H, Schmidt A, et al. Endoluminal stent-graft placement for acute rupture of the descending thoracic aorta. Eur Heart J. 2004;25:694–700.
Demers P, Miller C, Scott Mitchell R, et al. Chronic traumatic aneurysms of the descending thoracic aorta: mid-term results of endovascular repair using first and second-generation stent-grafts. Eur J Cardiothorac Surg. 2004;25:394–400.
Hultgren R, Larsson E, Wahlgren CM, Swedenborg J. Female and elderly abdominal aortic aneurysm patients more commonly have concurrent thoracic aortic aneurysm. Ann Vasc Surg. 2012;26:918–23.
Chaer RA, et al. Synchronous and metachronous thoracic aneurysms in patients with abdominal aortic aneurysms. J Vasc Surg. 2012;56:1261–5.
Karthikesalingam A, et al. The shortfall in long-term survival of patients with repaired thoracic or abdominal aortic aneurysms: retrospective case-control analysis of hospital episode statistics. Eur J Vasc Endovasc Surg. 2013;46:533–41.
Davies RR, Gallo A, Coady MA, Tellides G, Botta DM, Burke B, Coe MP, Kopf GS, Elefteriades JA. Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. Ann Thorac Surg. 2006;81:169–77.
Muhs BE, et al. Dynamic cine-CT angiography for the evaluation of the thoracic aorta; insight in dynamic changes with implications for thoracic endograft treatment. Eur J Vasc Endovasc Surg. 2006;32:532–6.
Elefteriades J. Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg. 2002;74:S1877–80.
Perreas K, Samanidis G, Dimitriou S, Kalogris P, Balanika M, Antzaka C, Khoury M, Michalis A. Outcomes after ascending aorta and proximal aortic arch repair using deep hypothermic circulatory arrest with retrograde cerebral perfusion: analysis of 207 patients. Interact Cardiovasc Thorac Surg. 2012;15:456–61.
Walsh SR, et al. Endovascular stenting versus open surgery for thoracic aortic disease: systematic review and meta-analysis of perioperative results. J Vasc Surg. 2008;47:1094–8.
Cheng D, et al. Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease. A systematic review and meta-analysis of comparative studies. J Am Coll Cardiol. 2010;55:986–1001.
Bavaria JE, et al. Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial. J Thorac Cardiovasc Surg. 2007;133:369–77.
Makaroun MS, Dillavou ED, Wheatley GH, Cambria RP. Five-year results of endovascular treatment with the Gore TAG device compared with open repair of thoracic aortic aneurysms. J Vasc Surg. 2008;47:912–8.
Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie N, et al. ESC guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J. 2010;31:2915–57.
Bissell MM, Hess AT, Biasiolli L, Glaze SJ, Loudon M, Pitcher A, et al. Aortic dilation in bicuspid aortic valve disease: flow pattern is a major contributor and differs with valve fusion type. Circ Cardiovasc Imaging. 2013;6:499–507.
Carr JA. The results of catheter-based therapy compared with surgical repair of adult aortic coarctation. J Am Coll Cardiol. 2006;47:1101–7.
Gibbs JL. Treatment options for coarctation of the aorta. Heart. 2000;84:11–3.
Mullen MJ. Coarctation of the aorta in adults: do we need surgeons? Heart. 2003;89:3–5.
Ovaert C, McCrindle BW, Nykanen D, et al. Balloon angioplasty of native coarctation: clinical outcomes and predictors of success. J Am Coll Cardiol. 2000;35:988–96.
Paddon AJ, Nicholson AA, Ettles DF, et al. Long-term follow-up of percutaneous balloon angioplasty in adult aortic coarctation. Cardiovasc Intervent Radiol. 2000;23:364–7.
Varma C, Benson LN, Butany J, et al. Aortic dissection after stent dilatation for coarctation of the aorta: a case report and literature review. Catheter Cardiovasc Interv. 2003;59:528–35.
Bell RE, Taylor PR, Aukett M, et al. Endoluminal repair of aneurysms associated with coarctation. Ann Thorac Surg. 2003;75:530–3.
Ince H, Petzsch M, Rehders T, et al. Percutaneous endovascular repair of aneurysm after previous coarctation surgery. Circulation. 2003;108:2967–70.
De Paepe A, Devereux RB, Dietz HC, Hennekam RC, Pyeritz RE. Revised diagnostic criteria for the Marfan syndrome. Am J Med Genet. 1996;62:417–26.
Collod G, et al. A second locus for Marfan syndrome maps to chromosome 3p24.2-p25. Nat Genet. 1994;8:264–8.
Milewicz DM, Pyeritz RE, Crawford S, Byers PH. Marfan syndrome: defective synthesis, secretion, and extracellular matrix formation of fibrillin by cultured dermal fibroblasts. J Clin Invest. 1992;89:79–86.
Kallenbach K, Baraki H, Khaladj N, Kamiya H, Hagl C, Haverich A, Karck M. Aortic valve-sparing operation in Marfan syndrome: what do we know after a decade? Ann Thorac Surg. 2007;83:S764–8.
Treasure T, Takkenberg JJ, Golesworthy T, Rega F, Petrou M, Rosendahl U, et al. Personalised external aortic root support (PEARS) in Marfan syndrome: analysis of 1-9 year outcomes by intention-to-treat in a cohort of the first 30 consecutive patients to receive a novel tissue and valve-conserving procedure, compared with the published results of aortic root replacement. Heart. 2014;100:969–75.
Singh SD, Xu XY, Pepper J, Izgi C, Treasure T, Mohiaddin RH. Effects of aortic root motion on wall stress in the Marfan aorta before and after personalised aortic root support (PEARS) surgery. J Biomech. 2016;49:2076–84.
Germain DP. Ehlers-Danlos syndrome type IV. Orphanet J Rare Dis. 2007;2:32.
Loeys BL, Schwarze U, Holm T, Callewaert BL, Thomas GH, Pannu H, et al. Aneurysm syndromes caused by mutations in the TGF-beta receptor. N Engl J Med. 2006;355:788–98.
Cooper DG, Walsh SR, Sadat U, Hayes PD, Boyle JR. Treating the thoracic aorta in Marfan syndrome: surgery or TEVAR? J Endovasc Ther. 2009;16:60–70.
Ince H, Rehders TC, Petzsch M, Kische S, Nienaber CA. Stent-grafts in patients with Marfan syndrome. J Endovasc Ther. 2005;12:82–8.
Adams JD, Kern JA. Blunt thoracic aortic injury: current issues and endovascular treatment paradigms. Endovasc Today. 2014;13:38–42.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer-Verlag GmbH Austria, part of Springer Nature
About this chapter
Cite this chapter
Mitsis, A., Nienaber, C.A. (2019). Endovascular Treatment of Aortic Diseases. In: Stanger, O., Pepper, J., Svensson, L. (eds) Surgical Management of Aortic Pathology. Springer, Vienna. https://doi.org/10.1007/978-3-7091-4874-7_82
Download citation
DOI: https://doi.org/10.1007/978-3-7091-4874-7_82
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-4872-3
Online ISBN: 978-3-7091-4874-7
eBook Packages: MedicineMedicine (R0)