Current Status of Endoluminal Treatment of Descending Thoracic Aortic Aneurysms
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REVIEW
ARTERIAL INTERVENTIONS
Current Status of Endoluminal Treatment of Descending Thoracic Aortic Aneurysms A. Claire Watkins1 • Alex Dalal1 • Jason T. Lee2 • Michael D. Dake3
Received: 22 December 2019 / Accepted: 9 May 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Thoracic endovascular aortic repair (TEVAR) was proved to be effective in thoracic descending aortic aneurysm (TDAA) repair in 1994 and approved by the FDA in 2005. Since then, TEVAR has become the firstline, recommended treatment for intact or ruptured DTAA or as a bridge to definitive open surgical repair in connective tissue disease. TEVAR has decreased perioperative morbidity and mortality compared to open surgery due to the lack of thoracotomy, aortic cross-clamping and left heart bypass. Improvement in materials, manufacturing and device delivery systems have allowed for the expansion of indications. Thoughtful and accurate pre-procedure planning is the hallmark of successful TEVAR. Familiarization and adherence to the instructions for use for an aortic device will give the best possible chance of success. Keywords Thoracic aortic aneurysm Thoracic endovascular aortic repair Aortic stent graft
Thoracic Endovascular Aortic Repair for Descending Thoracic Aortic Aneurysm *60% of all thoracic aortic aneurysms occur in the ascending aorta, while 40% occur in the descending aorta. *Early and midterm mortality and morbidity with TEVAR for aneurysm are superior to open surgical repair *Late-term mortality and morbidity with TEVAR for aneurysm are similar or superior to open surgical repair. *Highly calcified, thrombosed, short or conical proximal landing zones lead to type IA endoleak. *High risks of retrograde dissection include ascending aneurysm[ 4.5 cm, connective tissue disease, excessive stent graft oversizing. *The majority of type II endoleaks do not lead to aneurysmal dilation or rupture and can be managed conservatively. *Grade 2–4 blunt traumatic aortic injury warrants TEVAR with 2–10% stent graft oversizing. *Endovascular treatment of ruptured aortic aneurysm or dissection carries a significantly higher chance of survival than open surgery. *Complications of TEVAR for aneurysm include: spinal cord ischemia (2%), stroke (2%) and reintervention (20%) *Branched and fenestrated TEVAR devices allow a greater number of aneurysms to be treated endovascularly.
& Michael D. Dake [email protected] A. Claire Watkins [email protected] 1
Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
2
Division of Vascular Surgery, Stanford University, Stanford, CA, USA
3
University for Health Sciences, University of Arizona, Health Sciences Innovation Building, 9th Floor SVP Suite, 1670 E. Drachman Street, PO Box 210216, Tucson, AZ 85721-0216, USA
Key numbers Degenerative aneurysms > 5.5 cm in maximal diameter should be treated with TEVAR to avoid aortic complication and death. At least 2 cm healthy p
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