Skip to main content
SpringerLink
Log in

Current strategy of endovascular aortic repair for thoracic aortic aneurysms

  • Current Topics Review Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Thoracic aortic aneurysms are extremely burdensome to treat owing to their surgical complexity. In particular, major postoperative complications lower significantly patients’ quality of life. Surgical treatment has recently shifted to thoracic endovascular aortic repair (TEVAR) to respect the patients’ needs and improve postoperative quality of life. This procedure is radical and innovated for thoracic aortic pathology, but the devices and the delivery systems are immature because only a little over a decade and a half has passed since starting to use them. Ready-made stent-grafts were originally indicated only for degenerated aortic aneurysms, but aortic dissection and traumatic aortic transection will become the next targets for TEVAR. This review addresses the history and changes in TEVAR as well as the current TEVAR strategy. Finally, we describe a new trial of TEVAR for aortic dissections, traumatic aortic transections, and aortic arch aneurysms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Balko A, Piasecki GJ, Shah DM, Carney WI, Hopkins RW, Jackson BT. Transfemoral placement of intraluminal polyurethane prosthesis for abdominal aortic aneurysm, J Surg Res 1986;40:305–309.

    Article  PubMed  CAS  Google Scholar 

  2. Parodi JC, Palmatz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991;5:491–499.

    Article  PubMed  CAS  Google Scholar 

  3. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stentgrafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994331:1729–1734.

    Article  PubMed  CAS  Google Scholar 

  4. Kato M, Matsuda T, Kaneko M, Ueda T, Kuratani T, Yoshioka Y, et al. Experimental assessment of newly devised trans catheter stent-graft for aortic dissection. Ann Thorac Surg 1995;59:908–914.

    Article  PubMed  CAS  Google Scholar 

  5. Jackson BM, Carpenter JP, Fairman RM, Moser GW, Pochettino A, Woo EY, et al. Anatomic exclusion from endovascular repair of thoracic aortic aneurysm. J Vasc Surg 2007;45:662–666.

    Article  PubMed  Google Scholar 

  6. Kato M, Matsuda T, Kotoh K, Kaneko M, Imagawa H, Ueda T, et al. Development of a chronic endothelialized transcatheter implantable intra-aortic graft. ASAIO J 1993;39:M518–M521.

    Article  PubMed  CAS  Google Scholar 

  7. Makaroun MS, Dillavou ED, Wheatley GH, Cambria RP; Gore TAG Investigators. Five-year results of endovascular treatment with the Gore TAG device compared with open repair of thoracic aortic aneurysms. J Vasc Surg 2008;47:912–918.

    Article  PubMed  Google Scholar 

  8. Johansson G, Markstrom U, Sweedenborg J. Ruptured thoracic aortic aneurysms: a study of incidence and mortality rates. J Vasc Surg 1995;21:985–988.

    Article  PubMed  CAS  Google Scholar 

  9. Stone D, Brewster D, Kwolek C, Lamuraglia GM, Conrad MF, Chung TK, et al. Stent-graft versus open-surgical repair of thoracic aorta: mid-term results. J Vasc Surg 2006;44:1188–1197.

    Article  PubMed  Google Scholar 

  10. Shigemura N, Kato M, Kuratani T, Funakoshi Y, Kaneko M. New operative method for acute B dissection: left carotid artery-left subclavian artery bypass combined with endovascular stent-graft implantation. J Thorac Cardiovasc Surg 2000;120:406–408.

    Article  PubMed  CAS  Google Scholar 

  11. Kato M, Matsuda T, Kaneko M, Kuratani T, Mizushima T, Seo Y, et al. Outcomes of stent-graft treatment of false lumen in aortic dissection. Circulation 1998;98(suppl):II305–II3011; discussion II311–2.

    PubMed  CAS  Google Scholar 

  12. Makaroun M, Dillavou E, Kee S, Sicard G, Chaikof E, Bavaria J, et al. Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis. J Vasc Surg 2005;41:1–9.

    Article  PubMed  Google Scholar 

  13. Parmer SS, Carpenter JP, Stavropoulos SW, Fairman RM, Pochettino A, Woo EY, et al. Endo leaks after endovascular repair of thoracic aortic aneurysms. J Vasc Surg 2006;44:447–452.

    Article  PubMed  Google Scholar 

  14. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000;287:897–903.

    Article  Google Scholar 

  15. Verhoye JP, Miller DC, Sze D, Dake MD, Mitchell RS. Complicated acute type B aortic dissection: midterm results of emergency endovascular stent-grafting. J Thorac Cardiovasc Surg 2008;136:424–430.

    Article  PubMed  Google Scholar 

  16. Onitsuka S, Akashi H, Tayama K, Okazaki T, Ishihara K, Hiromatsu S, et al. Long-term outcome and prognostic predictors of medically treated acute type B aortic dissections. Ann Thorac Surg 2004;78:1268–1273.

    Article  PubMed  Google Scholar 

  17. Dake MD, Kato N, Mitchell RS, Semba CP, Razavi MK, Shimono T, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 1999;340:1546–1552.

    Article  PubMed  CAS  Google Scholar 

  18. Nienaber CA, Fattori R, Lund G, Dieckmann C, Wolf W, von Kodolitsch Y, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med 1999;340:1539–1545.

    Article  PubMed  CAS  Google Scholar 

  19. Umana JP, Lai DT, Mitchell RS, Moore KA, Rodriguez F, Robbins RC, et al. Is medical therapy still the optimal treatment strategy for patients with acute type B aortic dissections? J Thorac Cardiovasc Surg 2002;124:896–910.

    Article  PubMed  Google Scholar 

  20. Erbel R, Oelert H, Meyer J, Purh M, Mohr-Katoly S, Hausmann D, et al. Effect of medical and urgical therapy on aortic dissection evaluated by trans-esophageal echocardiography: implications for prognosis and therapy—The European Cooperative Study Group on Echocardiography. Circulation 1993;87:1604–1615.

    PubMed  CAS  Google Scholar 

  21. Eggebrecht H, Nienaber CA, Neuhauser M, Baumqart D, Kische S, Schmermund A, et al. Endovascular stent-graft placement in aortic dissection: a meta-analysis. Eur Heart J 2006;27:489–498.

    Article  PubMed  Google Scholar 

  22. Eggebrecht H, Herold U, Kuhnt O, Schmermund A, Bartel T, Martini S, et al. Endovascular stent-graft treatment of aortic dissection: determinants of post-interventional outcome. Eur Heart J 2005;26:489–497.

    Article  PubMed  Google Scholar 

  23. Erbel R, Alfonso F, Boileau C, Dirsch O, Eber B, Haverich A, et al. Diagnosis and management of aortic dissection. Eur Heart J 2001;22:1642–1681.

    Article  PubMed  CAS  Google Scholar 

  24. Nienaber CA, Erbel R, Ince H. Nihil nocere on the rocky road to endovascular stent-graft treatment. J Thorac Cardiovasc Surg 2004;127:620–621.

    Article  PubMed  Google Scholar 

  25. Bernard Y, Zimmermann H, Chocron S, Litzler JF, Kastler B, Etievent JP, et al. False lumen patency as a predictor of late outcome in aortic dissection. Am J Cardiol 2001;87:1378–1382.

    Article  PubMed  CAS  Google Scholar 

  26. Marui A, Mochizuki T, Mitsui N, Koyama T, Kimura F, Horibe M. Toward the best treatment for uncomplicated patients with type B acute aortic dissection: a consideration for sound surgical indication. Circulation 1999;100:II275–II280.

    PubMed  CAS  Google Scholar 

  27. Kato M, Bai H, Sato K, Kawamoto S, Kaneko M, Ueda T, et al. Determining surgical indications for acute type B dissection based on enlargement of aortic diameter during the chronic phase. Circulation 1995;92:II107–II112.

    PubMed  CAS  Google Scholar 

  28. Tehrani HY, Peterson BG, Katariya K, Morasch MD, Stevens R, DiLuozzo G, et al. Endovascular repair of thoracic aortic tears. Ann Thorac Surg 2006;82:873–878.

    Article  PubMed  Google Scholar 

  29. Zhou W, Reardon ME, Peden EK, Lin PH, Bush RL, Lumsden AB. Endovascular repair of a proximal aortic arch aneurysm: a novel approach of supra-aortic debranching with antegrade endograft deployment via an anterior thoracotomy approach. J Vasc Surg 2006;43:1045–1048.

    Article  PubMed  Google Scholar 

  30. Saleh HM, Inglese L. Combined surgical and endovascular treatment of aortic arch aneurysms. J Vasc Surg 2006;44:460–466.

    Article  PubMed  Google Scholar 

  31. Bergeron P, Mangialardi N, Costa P, Coulon P, Douillez V, Serreo E, et al. Great vessel management for endovascular exclusion of aortic arch aneurysms and dissections. Eur J Vasc Endovasc Surg 2006;32:38–45.

    Article  PubMed  CAS  Google Scholar 

  32. Shimamura K, Kuratani T, Mastumiya G, Shirakawa Y, Takeuchi M, Takano H, et al. Hybrid endovascualr aortic arch repair using branched endoprothesis: the second generation ‘branched’ open stent grafting technique. J Thorac Cardiovasc Surg 2009;138:46–53.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-9871, Japan

    Toru Kuratani & Yoshiki Sawa

Authors
  1. Toru Kuratani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshiki Sawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Toru Kuratani.

Additional information

This review was submitted at the invitation of the editorial committee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kuratani, T., Sawa, Y. Current strategy of endovascular aortic repair for thoracic aortic aneurysms. Gen Thorac Cardiovasc Surg 58, 393–398 (2010). https://doi.org/10.1007/s11748-009-0578-y

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-009-0578-y

Key words

Search

Navigation