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The Vienna aneurysm program

Combined vascular and endovascular approaches in the treatment of acute and chronic thoracic aortic disease

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Summary

The Vienna Aneurysm Program in its present form developed in the late 80ies. The main focus at that time was on the conventional treatment of acute and chronic thoracic aortic pathology with a special focus on thoracic and thoracoabdominal replacement [1–7]. By the advent of endovascular therapy in the mid 90ies, a new option for the treatment of acute and chronic thoracic aortic disease became available [8–14]. Simultaneously, substantial experimental as well as clinical work was performed with the main focus on cerebral and spinal cord protection [15–18]. Finally, in 2003, the options of endovascular therapy were extended into the arch and even into the ascending aorta via newly developed vascular rerouting procedures [19–23]. As a next step, the first acute type A dissection was successfully treated by endovascular stent-graft placement in 2005 [24, 25]. Recently, a new mechanism of disease and consecutively, a new treatment approach of intramural hematoma affecting the entire thoracic aorta has been reported [26]. The program has been steadily growing to a huge interdisciplinary group, encomprising cardiovascular surgeons as well as interventional radiologists. Overall, the numbers of patients presenting with aortic pathology are rising. Besides their usually advanced age, these patients suffer from significant comorbidities. Therefore, conventional aortic repair is associated with substantial risk. As a consequence, alternative approaches were warranted and have been developed to enable treatment of these patients. Combined approaches of various kinds have induced a change of mind in aortic medicine as the majority of patients today would have been refused any kind of treatment even a few years ago. Therefore, established limits have been transgressed. This article provides an overview of the current indications, surgical and endovascular approaches, results as well as a critical comment on all relevant issues concerning this exciting new field.

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References

  • Havel M, Teufelsbauer H, Knöbl P, et al (1991) Effect of intraoperative aprotinin administration on postoperative bleeding in patients undergoing cardiopulmonary bypass operation. J Thorac Cardiovasc Surg 101: 968–72

    PubMed  CAS  Google Scholar 

  • Grabenwöger M, Ehrlich M, Simon P, et al (1994) Thoracoabdominal aneurysm repair: spinal cord protection using profound hypothermia and circulatory arrest. J Card Surg 9: 679–84

    Article  PubMed  Google Scholar 

  • Ehrlich M, Grabenwöger M, Simon P, Laufer G, Wolner E, Havel M (1995) Surgical treatment of type A aortic dissections. Results with profound hypothermia and circulatory arrest. Tex Heart Inst J 22: 250–3

    PubMed  CAS  Google Scholar 

  • Ehrlich M, Grabenwöger M, Luckner D, et al (1996) Operative management of aortic arch aneurysm using profound hypothermia and circulatory arrest. J Cardiovasc Surg 37 [Suppl 1]: 63–4

    CAS  Google Scholar 

  • Ehrlich M, Grabenwöger M, Luckner D, et al (1997) The use of profound hypothermia and circulatory arrest in operations on the thoracic aorta. Eur J Cardiothorac Surg 11: 176–81

    Article  PubMed  CAS  Google Scholar 

  • Grabenwöger M, Ehrlich M, Cartes-Zumelzu F, et al (1997) Surgical treatment of aortic arch aneurysms in profound hypothermia and circulatory arrest. Ann Thorac Surg 64: 1067–71

    Article  PubMed  Google Scholar 

  • Ehrlich M, Grabenwöger M, Cartes-Zumelzu F, et al (1998) Operations on the thoracic aorta and hypothermic circulatory arrest: is aprotinin safe? J Thorac Cardiovasc Surg 115: 220–5

    Article  PubMed  CAS  Google Scholar 

  • Ehrlich M, Grabenwoeger M, Cartes-Zumelzu F, et al (1998) Endovascular stent graft repair for aneurysms on the descending thoracic aorta. Ann Thorac Surg 66: 19–24

    Article  PubMed  CAS  Google Scholar 

  • Grabenwöger M, Hutschala D, Ehrlich MP, et al (2000) Thoracic aortic aneurysms: treatment with endovascular self-expandable stent grafts. Ann Thorac Surg 69: 441–5

    Article  PubMed  Google Scholar 

  • Hutschala D, Fleck T, Czerny M, et al (2002) Endoluminal stent-graft placement in patients with acute aortic dissection type B. Eur J Cardiothorac Surg 21: 964–9

    Article  PubMed  CAS  Google Scholar 

  • Schoder M, Grabenwoger M, Holzenbein T, et al (2002) Endovascular stent-graft repair of complicated penetrating atherosclerotic ulcers of the descending thoracic aorta. J Vasc Surg 36: 720–6

    PubMed  Google Scholar 

  • Czerny M, Cejna M, Hutschala D, et al (2004) Stent-graft placement in atherosclerotic descending thoracic aortic aneurysms: midterm results. J Endovasc Ther 11: 26–32

    Article  PubMed  Google Scholar 

  • Czerny M, Fleck T, Zimpfer D, et al (2003) Combined repair of an aortic arch aneurysm by sequential transposition of the supraaortic branches and consecutive endovascular stent-graft placement. J Thorac Cardiovasc Surg 126: 916–8

    Article  PubMed  Google Scholar 

  • Czerny M, Zimpfer D, Fleck T, et al (2004) Initial results after combined repair of aortic arch aneurysms by sequential transposition of the supra-aortic branches and consecutive endovascular stent-graft placement. Ann Thorac Surg 78: 1256–60

    Article  PubMed  Google Scholar 

  • Ehrlich M, Fang WC, Grabenwöger M, Cartes-Zumelzu F, Wolner E, Havel M (1998) Perioperative risk factors for mortality in patients with acute type A aortic dissection. Circulation 98 [Suppl]: II294–8

    PubMed  CAS  Google Scholar 

  • Ehrlich M, Knolle E, Ciovica R, et al (1999) Memantine for prevention of spinal cord injury in a rabbit model. J Thorac Cardiovasc Surg 117: 285–91

    Article  PubMed  CAS  Google Scholar 

  • Ehrlich MP, Fang WC, Grabenwöger M, et al (1999) Impact of retrograde cerebral perfusion on aortic arch aneurysm repair. J Thorac Cardiovasc Surg 118: 1026–32

    Article  PubMed  CAS  Google Scholar 

  • Ehrlich MP, Hagl C, McCullough JN, et al (2001) Retrograde cerebral perfusion provides negligible flow through brain capillaries in the pig. J Thorac Cardiovasc Surg 122: 331–8

    Article  PubMed  CAS  Google Scholar 

  • Gottardi R, Zimpfer D, Funovics M, et al (2008) Mid-term results after endovascular stent-graft placement due to penetrating atherosclerotic ulcers of the thoracic aorta. Eur J Cardiothorac Surg 33: 1019–24

    Article  PubMed  Google Scholar 

  • Czerny M, Grimm M, Zimpfer D, et al (2007) Results after endovascular stent graft placement in atherosclerotic aneurysms involving the descending aorta. Ann Thorac Surg 83: 450–5

    Article  PubMed  Google Scholar 

  • Czerny M, Gottardi R, Zimpfer D, et al (2007) Mid-term results of supraaortic transpositions for extended endovascular repair of aortic arch pathologies. Eur J Cardiothorac Surg 31: 623–7

    Article  PubMed  Google Scholar 

  • Czerny M, Gottardi R, Zimpfer D, et al (2006) Transposition of the supraaortic branches for extended endovascular arch repair. Eur J Cardiothorac Surg 29: 709–13

    Article  PubMed  Google Scholar 

  • Gottardi R, Funovics M, Eggers N, et al (2008) Supraaortic transposition for combined vascular and endovascular repair of aortic arch pathology. Ann Thorac Surg (in press)

  • Zimpfer D, Schima H, Czerny M, et al (2008) Experimental stent-graft treatment of ascending aortic dissection. Ann Thorac Surg 85: 470–3

    Article  PubMed  Google Scholar 

  • Zimpfer D, Czerny M, Kettenbach J, et al (2000) Treatment of acute type a dissection by percutaneous endovascular stent-graft placement. Ann Thorac Surg 82: 747–9

    Article  Google Scholar 

  • Grimm M, Loewe C, Gottardi R, et al (2008) Novel insights into the mechanisms and treatment of intramural hematoma affecting the entire thoracic aorta. Ann Thorac Surg 86: 453–6

    Article  PubMed  Google Scholar 

  • Fleck T, Tschernich H, Grabenwoger M, et al (2003) A double patch sandwich technique for surgical repair of acute aortic dissection type A. Ann Thorac Surg 76: 499–502

    Article  PubMed  Google Scholar 

  • Westaby S, Katsumata T (1998) Proximal aortic perfusion for complex arch and descending aortic disease. J Thorac Cardiovasc Surg 115: 162–7

    Article  PubMed  CAS  Google Scholar 

  • Czerny M, Fleck T, Zimpfer D, et al (2003) Risk factors of mortality and permanent neurologic injury in patients undergoing ascending aortic and arch repair. J Thorac Cardiovasc Surg 126: 1296–301

    Article  PubMed  Google Scholar 

  • Wan S, Izzat MB, Lee TW, Wan IY, Tang NL, Yim AP (1999) Avoiding cardiopulmonary bypass in multivessel CABG reduces cytokine response and myocardial injury. Ann Thorac Surg 68: 52–6

    Article  PubMed  CAS  Google Scholar 

  • Strueber, Cremer JT, Gohrbandt B, et al (1999) Human cytokine responses to coronary artery bypass grafting with and without cardiopulmonary bypass. Ann Thorac Surg 68: 1330–5

    Article  Google Scholar 

  • Czerny M, Baumer H, Kilo J, et al (2000) Inflammatory response and myocardial injury following coronary artery bypass grafting with or without cardiopulmonary bypass. Eur J Cardiothorac Surg 17: 737–42

    Article  PubMed  CAS  Google Scholar 

  • Bachet J, Guilmet D, Goudot B, et al (1999) Antegrade cerebral perfusion with cold blood: a 13-year experience. Ann Thorac Surg 67: 1874–8

    Article  PubMed  CAS  Google Scholar 

  • Di Eusanio M, Schepens MA, Morshuis WJ, et al (2004) Separate grafts or en bloc anastomosis for arch vessels reimplantation to the aortic arch. Ann Thorac Surg 77: 2021–8

    Article  PubMed  Google Scholar 

  • Kazui T, Washiyama N, Muhammad BA, Terada H, Yamashita K, Takinami M (2001) Improved results of atherosclerotic arch aneurysm operations with a refined technique. J Thorac Cardiovasc Surg 121: 491–9

    Article  PubMed  CAS  Google Scholar 

  • Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5: 491–9

    Article  PubMed  CAS  Google Scholar 

  • Blum U, Langer M, Spillner G, et al (1996) Abdominal aortic aneurysms: preliminary technical and clincal results with transfemoral placement of endovascular self-expanding stent-grafts. Radiology 198: 25–31

    PubMed  CAS  Google Scholar 

  • Blum U, Voshage G, Lammer J, et al (1997) Endoluminal stent-grafts for infrarenal aortic aneurysms. N Engl J Med 2336: 13–20

    Article  Google Scholar 

  • Dake MD, Kato N, Mitchell RS, et al (1999) Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 340: 1546–52

    Article  PubMed  CAS  Google Scholar 

  • Nienaber CA, Fattori R, Lund G, et al (1999) Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med 340: 1539–45

    Article  PubMed  CAS  Google Scholar 

  • Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP (1994) Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 331: 1729–34

    Article  PubMed  CAS  Google Scholar 

  • von Segesser LK, Marty B, Tozzi P, et al (2004) Endovascular surgery for failed open aortic aneurysm repair. Eur J Cardiothorac Surg 26: 614–20

    Article  PubMed  Google Scholar 

  • Fattori R, Bacchi-Reggiani L, Bertaccini P, et al (2000) Evolution of aortic dissection after surgical repair. Am J Cardiol 86: 868–72

    Article  PubMed  CAS  Google Scholar 

  • Dambrin C, Marcheix B, Hollington L, Rousseau H (2005) Surgical treatment of an aortic arch aneurysm without cardiopulmonary bypass: endovascular stent-grafting after extra-anatomic bypass of supraaortic vessels. Eur J Cardiothorac Surg 27: 159–61

    Article  PubMed  Google Scholar 

  • Criado FJ, Barnatan MF, Rizk Y, Clark NS, Wang C (2002) Technical strategies to expand stent-graft applicability in the aortic arch and proximal descending thoracic aorta. J Endovasc Ther 9: II32–II38

    Article  PubMed  Google Scholar 

  • Buth J, Penn O, Tielbeek A, Mersman M (1998) Combined approach to stent-graft treatment of an aortic arch aneurysm. J Endovasc Surg 5: 329–32

    Article  PubMed  CAS  Google Scholar 

  • Iguro Y, Arata K, Yamamoto H, Masuda H, Sakata R (2002) A new concept in distal arch aneurysm repair with a stent graft. J Thorac Cardiovasc Surg 123: 378–80

    Article  PubMed  Google Scholar 

  • Okada K, Sueda T, Orihashi K, Watari M, Ishii O (2001) An alternative procedure of endovascular stent-graft repair for distal arch aortic aneurysm involving arch vessels. J Thorac Cardiovasc Surg 121: 182–4

    Article  PubMed  CAS  Google Scholar 

  • Nashef SAM, Roques F, Michel P, Gauducheau E, Lemeshow S, Salomon R the EuroSCORE Study Group (1999) European System for Cardiac Operative Risk Evaluation (EuroSCORE). Eur J Cardiothorac Surg 16: 9–13

    Article  PubMed  CAS  Google Scholar 

  • Michel P, Roques F, Nashef SAM (2003) Logistic or additive EuroSCORE for high-risk patients. Eur J Cardiothorac Surg 23: 684–87

    Article  PubMed  Google Scholar 

  • Vogt PR, Brunner-La Rocca HP, et al (1998) Cryopreserved vascular allograft in the treatment of major vascular infection: a comparison with conventional surgical techniques. J Thorac Cardiovasc Surg 116: 965–72

    Article  PubMed  CAS  Google Scholar 

  • Weigang E, Parker J, Czerny M, et al (2008) Endovascular repair of aortic arch after aortic arch debranching. Ann Thorac Surg (in press)

  • Weigang E, Luehr M, Harloff A, et al (2007) Incidence of neurological complications following overstenting of the left subclavian artery. Eur J Cardiothorac Surg 31: 628–36

    Article  PubMed  Google Scholar 

  • Griepp RB, Ergin MA, Galla JD, et al (1999) Natural history of descending thoracic and thoracoabdominal aneurysms. Ann Thorac Surg 67: 1927–30

    Article  PubMed  CAS  Google Scholar 

  • Coselli JS, de Figueiredo LF (1997) Natural history of descending and thoracoabdominal aortic aneurysms. J Card Surg 12 [2 Suppl]: 285–9

    PubMed  CAS  Google Scholar 

  • Barron DJ, Livesey SA, Brown IW, Delaney DJ, Lamb RK, Monro JL (1997) Twenty-year follow-up of acute type a dissection: the incidence and extent of distal aortic disease using magnetic resonance imaging. J Card Surg 12: 147–59

    Article  PubMed  CAS  Google Scholar 

  • Cho KR, Stanson AW, Potter DD, Cherry KJ, Schaff HV, Sundt TM (2004) Penetrating atherosclerotic ulcer of the descending thoracic aorta and arch. J Thorac Cardiovasc Surg 127: 1393–401

    Article  PubMed  Google Scholar 

  • Criado F, Abul-Khoudoud OR, Domer GS, et al (2005) Endovascular repair of the thoracic aorta: lessons learned. Ann Thorac Surg 80: 857–63

    Article  PubMed  Google Scholar 

  • Schumacher H, Badenheuer H, Hansmann J, Allenberg JR (2003) Endovascular aortic arch reconstruction with supra-aortic transposition for symptomatic contained rupture and dissection: early experience in 8 high-risk patients. J Endovasc Ther 10: 1066–74

    Article  PubMed  Google Scholar 

  • Harris P, Brennan J, Martin J, et al (1999) Longitudinal aneurysm shrinkage following endovascular aortic aneurysm repair: a source of intermediate and late complications. J Endovasc Surg 6: 11–6

    Article  PubMed  CAS  Google Scholar 

  • Harris P, Buth J, Mialhe C, et al (1997) The need for clinical trials of endovascular abdominal aortic aneurysm repair: the Eurostar Project. J Endovasc Surg 4: 72–7

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria

    Martin Czerny, Marek Ehrlich, Martin Grabenwoger, Michael Havel & Michael Grimm

  2. Department of Interventional Radiology, University of Vienna Medical School, Vienna, Austria

    Johannes Lammer

Authors
  1. Martin Czerny
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  2. Marek Ehrlich
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  3. Martin Grabenwoger
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  4. Michael Havel
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  5. Johannes Lammer
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  6. Michael Grimm
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Correspondence to Martin Czerny.

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Czerny, M., Ehrlich, M., Grabenwoger, M. et al. The Vienna aneurysm program. Wien Klin Wochenschr 120 (Suppl 2), 21–28 (2008). https://doi.org/10.1007/s00508-008-1047-9

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