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TEVAR

The solution to all aortic problems?

TEVAR

Die Lösung alle Aortenrkrankungen?

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Abstract

Chronic as well as acute diseases of the thoracic aorta are attracting increasing attention, both in the light of an ageing Western and Oriental population and with the proliferation of modern diagnostic imaging modalities. While classic surgical strategies still dominate the treatment of pathology of the ascending aorta and the proximal arch region, new endovascular concepts are emerging and are likely to evolve as primary treatment strategies for descending and abdominal aortic pathology. Additionally, aortic arch pathologies are becoming the target of hybrid approaches combining surgical head-vessel debranching and interventional stent-graft implantation in an attempt to improve outcome by avoiding the high risk of open arch repair or complete replacement. Nonetheless, due to the complexity of the underlying vascular disease, each patient should be discussed in a team consisiting of cardiologists, cardiac surgeons, and an imaging specialist in order to design an individualized therapeutic strategy carried out best in a center with experience in both endovascular and surgical procedures.

Zusammenfassung

Akute und chronische Aortenerkrankungen gewinnen aufgrund des zunehmenden Alters der Bevölkerung und der verbesserten Diagnostik an Bedeutung. Die operative Therapie stellt weiterhin den Goldstandard der Behandlung von pathologischen Veränderungen im Bereich der Aorta ascendens dar. Interventionelle endoluminale Therapiemöglichkeiten stellen angesichts des wissenschaftlichen Erkenntnisgewinns eine Alternative in der Behandlung von pathologischen Veränderungen im Bereich der Aorta descendens dar. Zudem können sie in Kombination mit der operativen Therapie in der Hybridtherapie des Aortenbogens eingesetzt werden. Obwohl in nichtrandomisierten Studien sogar eine Überlegenheit im Vergleich zur operativen Therapiestrategie aufgezeigt werden konnte, sollte aufgrund der hohen Komplexität der Erkrankungen weiterhin eine individuelle Besprechung der Befunde in einem Team aus Kardiologen, Herzchirurgen sowie Spezialisten der Bildgebung erfolgen. Die Therapie sollte in Zentren mit ausgewiesener Expertise durchgeführt werden.

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The corresponding author states that there are no conflicts of interest.

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  1. Heart Center Rostock, Department of Internal Medicine I, University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland

    I. Akin, S. Kische, T.C. Rehders, H. Schneider, H. Ince & C.A. Nienaber MD, PhD

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  1. I. Akin
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  2. S. Kische
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  3. T.C. Rehders
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  4. H. Schneider
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  5. H. Ince
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  6. C.A. Nienaber MD, PhD
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Correspondence to C.A. Nienaber MD, PhD.

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Akin, I., Kische, S., Rehders, T. et al. TEVAR. Herz 36, 539–547 (2011). https://doi.org/10.1007/s00059-011-3500-1

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