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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.


Related in: MedlinePlus

Contrast-medium enhanced MR angiography of the aorta in a case of aortic arch aneurysm. A– aneurysm of the aortic arch involving the supra-aortic branches. B– post-interventional/-surgical result after hybrid procedure with debranching of the supra-aortic vessels and stent-graft implantation in the aortic arch
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Figure 3: Contrast-medium enhanced MR angiography of the aorta in a case of aortic arch aneurysm. A– aneurysm of the aortic arch involving the supra-aortic branches. B– post-interventional/-surgical result after hybrid procedure with debranching of the supra-aortic vessels and stent-graft implantation in the aortic arch

Mentions: The aortic arch morphology is challenging because of angulations and the proximity of the supra-aortic branches, which need to be preserved. Traditional open arch reconstruction using hypothermic cardiac arrest, extracorporeal circulation and selective cerebral perfusion has been demonstrated to effectively manage aortic arch pathologies. However, this current standard procedure for any arch pathology carries significant mortality (2-9%) and risk of paraplegia and cerebral stroke in 4-13% of cases [19]. Therefore, open repair is often reserved for low-risk patients. Hybrid arch procedures (HAP) are a combination of debranching bypass (supra-aortic vessel transposition) to establish cerebral perfusion and subsequent thoracic endografting to provide patient-centred solutions for complex aortic arch lesions (Figure 3). HAP is performed without hypothermic circulatory arrest and extracorporeal circulation and could expand the treatment group to older patients with severe comorbidities and redo-surgery currently ineligible for open surgical intervention. There are two different hybrid approaches with either extra-anatomic or intrathoracic supra-aortic vessel transposition. To treat distal arch aneurysms involving both the left subclavian and the left common carotid artery, those vessels can be translocated upstream to the right common carotid artery approached via cervical access (hemi-arch debranching) [20]. For arch aneurysms extending to the innominate artery the ascending aorta can be used, via sternotomy, as a donor site to revascularize all three supra-aortic arteries (total arch debranching). The key to success is the quality of the unimpaired ascending aorta as a donor site for the debranching bypass and proximal landing zone for the stent grafts.


Endovascular repair of thoracic aortic aneurysm.

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

Contrast-medium enhanced MR angiography of the aorta in a case of aortic arch aneurysm. A– aneurysm of the aortic arch involving the supra-aortic branches. B– post-interventional/-surgical result after hybrid procedure with debranching of the supra-aortic vessels and stent-graft implantation in the aortic arch
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Contrast-medium enhanced MR angiography of the aorta in a case of aortic arch aneurysm. A– aneurysm of the aortic arch involving the supra-aortic branches. B– post-interventional/-surgical result after hybrid procedure with debranching of the supra-aortic vessels and stent-graft implantation in the aortic arch
Mentions: The aortic arch morphology is challenging because of angulations and the proximity of the supra-aortic branches, which need to be preserved. Traditional open arch reconstruction using hypothermic cardiac arrest, extracorporeal circulation and selective cerebral perfusion has been demonstrated to effectively manage aortic arch pathologies. However, this current standard procedure for any arch pathology carries significant mortality (2-9%) and risk of paraplegia and cerebral stroke in 4-13% of cases [19]. Therefore, open repair is often reserved for low-risk patients. Hybrid arch procedures (HAP) are a combination of debranching bypass (supra-aortic vessel transposition) to establish cerebral perfusion and subsequent thoracic endografting to provide patient-centred solutions for complex aortic arch lesions (Figure 3). HAP is performed without hypothermic circulatory arrest and extracorporeal circulation and could expand the treatment group to older patients with severe comorbidities and redo-surgery currently ineligible for open surgical intervention. There are two different hybrid approaches with either extra-anatomic or intrathoracic supra-aortic vessel transposition. To treat distal arch aneurysms involving both the left subclavian and the left common carotid artery, those vessels can be translocated upstream to the right common carotid artery approached via cervical access (hemi-arch debranching) [20]. For arch aneurysms extending to the innominate artery the ascending aorta can be used, via sternotomy, as a donor site to revascularize all three supra-aortic arteries (total arch debranching). The key to success is the quality of the unimpaired ascending aorta as a donor site for the debranching bypass and proximal landing zone for the stent grafts.

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