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Current Status of Endoluminal Treatment of Descending Thoracic Aortic Aneurysms

CardioVascular and Interventional Radiology volume 43, pages 1770–1778 (2020)Cite this article

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 first-line, 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.

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References

  1. Hiratzka LF, Bakris GL, Beckman JA, et al. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology,American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55(14):e27–e129.

    Article  PubMed  Google Scholar 

  2. Kuzmik GA, Sang AX, Elefteriades JA. Natural history of thoracic aortic aneurysms. J Vasc Surg. 2012;56(2):565–71.

    Article  PubMed  Google Scholar 

  3. Isselbacher EM. Thoracic and abdominal aortic aneurysms. Circulation. 2005;111(6):816–28.

    Article  PubMed  Google Scholar 

  4. Coady MA, Rizzo JA, Hammond GL, et al. What is the appropriate size criterion for resection of thoracic aortic aneurysms? J Thorac Cardiovasc Surg. 1997;113(3):476–91 discussion 489-491.

    Article  CAS  PubMed  Google Scholar 

  5. De Bakey ME, Cooley DA. Successful resection of aneurysm of thoracic aorta and replacement by graft. J Am Med Assoc. 1953;152(8):673–6.

    Article  Google Scholar 

  6. Achneck HE, Rizzo JA, Tranquilli M, Elefteriades JA. Safety of thoracic aortic surgery in the present era. Ann Thorac Surg. 2007;84(4):1180–5 discussion 1185.

    Article  PubMed  Google Scholar 

  7. Goodney PP, Travis L, Lucas FL, et al. Survival after open versus endovascular thoracic aortic aneurysm repair in an observational study of the Medicare population. Circulation. 2011;124(24):2661–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Riambau V, Böckler D, Brunkwall J, Cao P, et al. Management of descending thoracic aorta diseases: clinical practice guidelines of the european society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg. 2017;53(1):4–52.

    Article  CAS  PubMed  Google Scholar 

  9. Makaroun MS, Dillavou ED, Wheatley GH, Cambria RP, Investigators GT. Five-year results of endovascular treatment with the gore TAG device compared with open repair of thoracic aortic aneurysms. J Vasc Surg. 2008;47(5):912–8.

    Article  PubMed  Google Scholar 

  10. Jordan WD Jr, Rovin J, Moainie S, Bavaria J, et al. Results of a prospective multicenter trial of CTAG thoracic endograft. J Vasc Surg. 2015;61(3):589–95.

    Article  PubMed  Google Scholar 

  11. Farber MA, Giglia JS, Starnes BW, Stevens SL, et al. Evaluation of the redesigned conformable GORE TAG thoracic endoprosthesis for traumatic aortic transection. J Vasc Surg. 2013;58(3):651–8.

    Article  PubMed  Google Scholar 

  12. Antonello M, Squizzato F, Dall'Antonia A, Grego F, Piazza M. GORE TAG thoracic endograft with active control system: landing accuracy and wall apposition in an initial clinical experience. Ann Vasc Surg. 2019;58:261–9.

    Article  PubMed  Google Scholar 

  13. Conrad MF, Tuchek J, Freezor R, Bavaria J, et al. Results of the VALOR II trial of the medtronic valiant thoracic stent graft. J Vasc Surg. 2017 Aug;66(2):335–42.

    Article  PubMed  Google Scholar 

  14. Azizzadeh A, Desai N, Arko FR 3rd, Panneton JM, et al. Pivotal results for the valiant navion stent graft system in the valiant EVO global clinical trial. J Vasc Surg. 2019 Nov;70(5):1399–1408.e1.

    Article  PubMed  Google Scholar 

  15. Matsumura JS, Melissano G, Cambria RP, Dake MD, et al. Zenith TX2 clinical trial investigators. five-year results of thoracic endovascular aortic repair with the Zenith TX2. J Vasc Surg. 2014;60(1):1–10.

    Article  PubMed  Google Scholar 

  16. Illig KA, Ohki T, Hughes GC, Kato M, et al. Zenith TX2 low profile study investigators. one-year outcomes from the international multicenter study of the Zenith alpha thoracic endovascular graft for thoracic endovascular repair. J Vasc Surg. 2015;62(6):1485–94.e2.

    Article  PubMed  Google Scholar 

  17. Farber MA, Lee WA, Szeto WY, Panneton JM, Kwolek CJ. Initial and midterm results of the Bolton Relay thoracic aortic endovascular pivotal trial. J Vasc Surg. 2017;65(6):1556–1566.e1.

    Article  PubMed  Google Scholar 

  18. Salihi S, Saçlı H, Erkengel HI, Kara I. Mid-term outcomes of thoracic endovascular aortic repair for complicated type B aortic dissection. Turk J Vasc Surg. 2020;29(1):26–31.

    Google Scholar 

  19. Wojciechowski J, Znaniecki L, Bury K, Rogowski J. Thoracic endovascular aortic repair with left subclavian artery coverage without prophylactic revascularization—early and midterm results. Langenbeck's Arch Surg. 2014;399: 619 627

    Article  CAS  Google Scholar 

  20. Harky A, Kai Chan JS, Ming Wong CH, Bashir M. Open versus endovascular repair of descending thoracic aortic aneurysm disease: a systematic review and meta-analysis. Ann Vasc Surg. 2019;54(304–315):e305.

    Google Scholar 

  21. Arnaoutakis DJ, Arnaoutakis GJ, Abularrage CJ, et al. Cohort comparison of thoracic endovascular aortic repair with open thoracic aortic repair using modern end-organ preservation strategies. Ann Vasc Surg. 2015;29(5):882–90.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Chiu P, Goldstone AB, Schaffer JM, et al. Endovascular versus open repair of intact descending thoracic aortic aneurysms. J Am Coll Cardiol. 2019;73(6):643–51.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Davies RR, Gallo A, Coady MA, et al. Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms. Ann Thorac Surg. 2006;81(1):169–77.

    Article  PubMed  Google Scholar 

  24. Bradshaw RJ, Ahanchi SS, Powell O, et al. Left subclavian artery revascularization in zone 2 thoracic endovascular aortic repair is associated with lower stroke risk across all aortic diseases. J Vasc Surg. 2017;65(5):1270–9.

    Article  PubMed  Google Scholar 

  25. Ranney DN, Cox ML, Yerokun BA, et al. Long-term results of endovascular repair for descending thoracic aortic aneurysms. J Vasc Surg. 2018;67(2):363–8.

    Article  PubMed  Google Scholar 

  26. Lee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the society for vascular surgery. J Vasc Surg. 2011;53(1):187–92.

    Article  PubMed  Google Scholar 

  27. Marcaccio CL, Dumas RP, Huang Y, Yang W, Wang GJ, Holena DN. Delayed endovascular aortic repair is associated with reduced in-hospital mortality in patients with blunt thoracic aortic injury. J Vasc Surg. 2018;68(1):64–73.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cheng YT, Cheng CT, Wang SY, Wu VC, Chu PH, Chou AH, Chen CC, Ko PJ, Liu KS, Chen SW. Long-term outcomes of endovascular and open repair for traumatic thoracic aortic injury. JAMA Netw Open. 2019;2(2):e187861.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Patel HJ, Azizzadeh A, Matsumoto AH, Velazquez OC, Rovin JD, Lombardi JV, Khoynezhad A, Dai Y, White RA. (2020) five-year outcomes from the United States pivotal trial of valiant captivia stent graft for Blunt aortic injury. Ann Thorac Surg. Jan 25. [epub ahead of print]

  30. Sörelius K, Wanhainen A, Wahlgren CM, Langenskiöld M, Roos H, et al. Nationwide study on treatment of mycotic thoracic aortic aneurysms. Eur J Vasc Endovasc Surg. 2019;57(2):239–46.

    Article  PubMed  Google Scholar 

  31. Sörelius K, Mani K, Björck M, Sedivy P, Wahlgren CM, et al. Endovascular treatment of mycotic aortic aneurysms: a European multicenter study. Circulation. 2014;130(24):2136–42.

    Article  PubMed  CAS  Google Scholar 

  32. Jonker FH, Verhagen HJ, Lin PH, Heijmen RH, Trimarchi S, Lee WA, Moll FL, Athamneh H, Muhs BE. Outcomes of endovascular repair of ruptured descending thoracic aortic aneurysms. Circulation. 2010;121(25):2718–23.

    Article  PubMed  Google Scholar 

  33. Hammo S, Larzon T, Hultgren R, Wanhainen A, Mani K, et al. Outcome after endovascular repair of ruptured descending thoracic aortic aneurysm: a national multicentre study. Eur J Vasc Endovasc Surg. 2019;57(6):788–94.

    Article  PubMed  Google Scholar 

  34. Jonker FH, Verhagen HJ, Lin PH, Heijmen RH, Trimarchi S, Lee WA, Moll FL, Atamneh H, Rampoldi V, Muhs BE. Open surgery versus endovascular repair of ruptured thoracic aortic aneurysms. J Vasc Surg. 2011;53(5):1210–6.

    Article  PubMed  Google Scholar 

  35. Ogawa Y, Watkins AC, Lingala B, Itoga N, Chiu P, Iwakoshi S, He H, Lee JT, Ficshbein MP, Woo YJ, Dake MD. Improved mid-term outcomes following endovascular repair of non-traumatic descending thoracic aortic rupture compared to open surgery. J Thorac Cardiovasc Surg. 2019;S0022–5223(19)33069–7.

  36. Locham S, Dakour-Aridi H, Nejim B, Dhaliwal J, Alshwaily W, Malas M. Outcomes and cost of open versus endovascular repair of intact thoracoabdominal aortic aneurysm. J Vasc Surg. 2018;68(4):948–955.e1.

    Article  PubMed  Google Scholar 

  37. Alhussaini M, Arnaoutakis GJ, Scali ST, Giles KA, Fatima J, Back M, Arnaoutakis D, Jeng EI, Martin TD, Neal D, Beaver TM. Impact of secondary aortic interventions after thoracic endovascular aortic repair on long-term survival. Ann Thorac Surg. 2019. https://doi.org/10.1016/j.athoracsur.2019.10.015.

    Article  PubMed  Google Scholar 

  38. Scali ST, Beck AW, Butler K, Feezor RJ, Martin TD, Hess PJ, Huber TS, Chang CK. Pathology-specific secondary aortic interventions after thoracic endovascular aortic repair. J Vasc Surg. 2014;59(3):599–607.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA

    A. Claire Watkins & Alex Dalal

  2. Division of Vascular Surgery, Stanford University, Stanford, CA, USA

    Jason T. Lee

  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

    Michael D. Dake

Authors
  1. A. Claire Watkins
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  2. Alex Dalal
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  4. Michael D. Dake
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Corresponding author

Correspondence to Michael D. Dake.

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Conflicts of interest

MDD is a consultant for Cook Medical and on the medical advisory board at WL Gore. CAW is a consultant for WL Gore and Terumo Aortic.

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Watkins, A.C., Dalal, A., Lee, J.T. et al. Current Status of Endoluminal Treatment of Descending Thoracic Aortic Aneurysms. Cardiovasc Intervent Radiol 43, 1770–1778 (2020). https://doi.org/10.1007/s00270-020-02526-1

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  • DOI: https://doi.org/10.1007/s00270-020-02526-1

Keywords

  • Thoracic aortic aneurysm
  • Thoracic endovascular aortic repair
  • Aortic stent graft