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Endovascular repair of thoracic aortic aneurysm.

Akin I, Kische S, Rehders TC, Nienaber CA, Rauchhaus M, Ince H - Arch Med Sci (2010)

Bottom Line: The risk of rupture for untreated aneurysms beyond a diameter of 5.6 cm ranges from 46% to 74% and the two-year mortality rate is greater than 70%, with most deaths resulting from rupture.Treatment options include surgical and non-surgical repair to prevent aneurysm enlargement and rupture.While most cases of ascending aortic involvement are subject to surgical repair (partially with valve-preserving techniques), aneurysm of the distal arch and descending thoracic aorta are amenable to emerging endovascular techniques as an alternative to classic open repair or to a hybrid approach (combining debranching surgery with stent grafting) in an attempt to improve outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine I, Divisions of Cardiology, Pulmonology and Intensive Care Unit, University Hospital Rostock, Rostock School of Medicine, Rostock, Germany.

ABSTRACT
A thoracic aortic aneurysm (TAA) is a potentially life-threatening condition with structural weakness of the aortic wall, which can progress to arterial dilatation and rupture. Today, both an increasing awareness of vascular disease and the access to tomographic imaging facilitate the diagnosis of TAA even in an asymptomatic stage. The risk of rupture for untreated aneurysms beyond a diameter of 5.6 cm ranges from 46% to 74% and the two-year mortality rate is greater than 70%, with most deaths resulting from rupture. Treatment options include surgical and non-surgical repair to prevent aneurysm enlargement and rupture. While most cases of ascending aortic involvement are subject to surgical repair (partially with valve-preserving techniques), aneurysm of the distal arch and descending thoracic aorta are amenable to emerging endovascular techniques as an alternative to classic open repair or to a hybrid approach (combining debranching surgery with stent grafting) in an attempt to improve outcomes.

No MeSH data available.


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(A) CT angiogram showing a circumscript aneurysm of the descending thoracic aorta in a middle-aged male patient selected for endografting. (B) 1-year follow-up after successful endovascular exclusion of the aneurysm by stent-graft placement demonstrates marked shrinkage of periprosthetic aneurysm and optimal wall apposition of the stent graft
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Figure 1: (A) CT angiogram showing a circumscript aneurysm of the descending thoracic aorta in a middle-aged male patient selected for endografting. (B) 1-year follow-up after successful endovascular exclusion of the aneurysm by stent-graft placement demonstrates marked shrinkage of periprosthetic aneurysm and optimal wall apposition of the stent graft

Mentions: Endovascular treatment of thoracic aortic aneurysms is achieved by transluminal placement of one or more stent-graft devices across the longitudinal extent of the lesion. The prosthesis bridges the aneurismal sac to exclude it from high-pressure aortic blood flow, thereby allowing for sac thrombosis around the stent graft and possible remodelling of the aortic wall (Figure 1). Thoracotomy, aortic cross-clamping, left-heart bypass, and single-lung ventilation are all avoided with an endovascular aortic procedure. The use of stent grafts was first reported by Volodos et al. in 1986 in a patient with post-traumatic pseudoaneurysm of the thoracic aorta [11]. With technology proceeding at a fast pace, both custom-designed and commercially available stent grafts are available for treating thoracic aortic disease (Figure 2). By now, several institutions have substantiated both the safety and the effectiveness of stent grafts for the repair of thoracic aortic aneurysms [12-14]. With increasing endovascular experience numerous other aortic diseases, such as aortic dissection, penetrating atherosclerotic ulcers, aortopulmonary fistulas, acute aortic rupture from blunt chest trauma, and mycotic aneurysms, have been investigated as a potential indication for endovascular treatment.


Endovascular repair of thoracic aortic aneurysm.

Akin I, Kische S, Rehders TC, Nienaber CA, Rauchhaus M, Ince H - Arch Med Sci (2010)

(A) CT angiogram showing a circumscript aneurysm of the descending thoracic aorta in a middle-aged male patient selected for endografting. (B) 1-year follow-up after successful endovascular exclusion of the aneurysm by stent-graft placement demonstrates marked shrinkage of periprosthetic aneurysm and optimal wall apposition of the stent graft
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3298329&req=5

Figure 1: (A) CT angiogram showing a circumscript aneurysm of the descending thoracic aorta in a middle-aged male patient selected for endografting. (B) 1-year follow-up after successful endovascular exclusion of the aneurysm by stent-graft placement demonstrates marked shrinkage of periprosthetic aneurysm and optimal wall apposition of the stent graft
Mentions: Endovascular treatment of thoracic aortic aneurysms is achieved by transluminal placement of one or more stent-graft devices across the longitudinal extent of the lesion. The prosthesis bridges the aneurismal sac to exclude it from high-pressure aortic blood flow, thereby allowing for sac thrombosis around the stent graft and possible remodelling of the aortic wall (Figure 1). Thoracotomy, aortic cross-clamping, left-heart bypass, and single-lung ventilation are all avoided with an endovascular aortic procedure. The use of stent grafts was first reported by Volodos et al. in 1986 in a patient with post-traumatic pseudoaneurysm of the thoracic aorta [11]. With technology proceeding at a fast pace, both custom-designed and commercially available stent grafts are available for treating thoracic aortic disease (Figure 2). By now, several institutions have substantiated both the safety and the effectiveness of stent grafts for the repair of thoracic aortic aneurysms [12-14]. With increasing endovascular experience numerous other aortic diseases, such as aortic dissection, penetrating atherosclerotic ulcers, aortopulmonary fistulas, acute aortic rupture from blunt chest trauma, and mycotic aneurysms, have been investigated as a potential indication for endovascular treatment.

Bottom Line: The risk of rupture for untreated aneurysms beyond a diameter of 5.6 cm ranges from 46% to 74% and the two-year mortality rate is greater than 70%, with most deaths resulting from rupture.Treatment options include surgical and non-surgical repair to prevent aneurysm enlargement and rupture.While most cases of ascending aortic involvement are subject to surgical repair (partially with valve-preserving techniques), aneurysm of the distal arch and descending thoracic aorta are amenable to emerging endovascular techniques as an alternative to classic open repair or to a hybrid approach (combining debranching surgery with stent grafting) in an attempt to improve outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine I, Divisions of Cardiology, Pulmonology and Intensive Care Unit, University Hospital Rostock, Rostock School of Medicine, Rostock, Germany.

ABSTRACT
A thoracic aortic aneurysm (TAA) is a potentially life-threatening condition with structural weakness of the aortic wall, which can progress to arterial dilatation and rupture. Today, both an increasing awareness of vascular disease and the access to tomographic imaging facilitate the diagnosis of TAA even in an asymptomatic stage. The risk of rupture for untreated aneurysms beyond a diameter of 5.6 cm ranges from 46% to 74% and the two-year mortality rate is greater than 70%, with most deaths resulting from rupture. Treatment options include surgical and non-surgical repair to prevent aneurysm enlargement and rupture. While most cases of ascending aortic involvement are subject to surgical repair (partially with valve-preserving techniques), aneurysm of the distal arch and descending thoracic aorta are amenable to emerging endovascular techniques as an alternative to classic open repair or to a hybrid approach (combining debranching surgery with stent grafting) in an attempt to improve outcomes.

No MeSH data available.


Related in: MedlinePlus