scholarly journals Perioperative Hemodynamic Management and Pharmacotherapeutics of Patients Undergoing Thoracic Endovascular Aortic Repair

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Anja Muehle ◽  
Isil Uzun ◽  
Ziba Jalali ◽  
Ali Khoynezhad
Keyword(s):  
Blood Pressure ◽  
Aortic Disease ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Long Term Results ◽  
Safe Procedure ◽  
Thoracic Aortic Disease ◽  
Hemodynamic Management ◽  
Aortic Repair ◽  
Alternative Treatment Option

Thoracic endovascular aortic repair (TEVAR) has become an attractive alternative treatment option for many patients with specific thoracic aortic disease. New devices and advanced image-guided procedures are continuously expanding the indications and improve neurological outcomes. Hemodynamic management of these patients is a critical aspect in reducing neurological deficit and it is different compared to patients undergoing open thoracic aortic operations. There are two different phases of blood pressure management for patients with thoracic aortic disease. Before and during the critical steps of TEVAR anti-impulsive therapy facilitates safe positioning and stent deployment. After stent grafts are deployed, controlled hypertensive blood pressure levels are achieved to avoid spinal cord ischemia. This precise blood pressure strategy is essential to ensure a safe procedure and good long-term results.

scholarly journals Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association for Cardio-Thoracic Surgery (EACTS)

2020 ◽  
Vol 59 (1) ◽  
pp. 65-73 ◽  
Author(s):  
Martin Czerny ◽  
Davide Pacini ◽  
Victor Aboyans ◽  
Nawwar Al-Attar ◽  
Holger Eggebrecht ◽  
...  
Keyword(s):  
Working Group ◽  
European Association ◽  
Aortic Disease ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Current Evidence ◽  
Heart Team ◽  
Acute Type ◽  
Thoracic Aortic Disease ◽  
Aortic Repair

Abstract Since its clinical implementation in the late nineties, thoracic endovascular aortic repair (TEVAR) has become the standard treatment of several acute and chronic diseases of the thoracic aorta. While TEVAR has been embraced by many, this disruptive technology has also stimulated the continuing evolution of open surgery, which became even more important as late TEVAR failures do need open surgical correction justifying the need to unite both treatment options under one umbrella. This fact shows the importance of—in analogy to the heart team—aortic centre formation and centralization of care, which stimulates continuing development and improves outcome . The next frontier to be explored is the most proximal component of the aorta—the aortic root, in particular in acute type A aortic dissection—which remains the main challenge for the years to come. The aim of this document is to provide the reader with a synopsis of current evidence regarding the use or non-use of TEVAR in acute and chronic thoracic aortic disease, to share latest recommendations for a modified terminology and for reporting standards and finally to provide a glimpse into future developments.

scholarly journals A review of endovascular treatment of thoracic aorta disease

2018 ◽  
Vol 100 (8) ◽  
pp. 662-668 ◽  
Author(s):  
GJS Tan ◽  
PLZ Khoo ◽  
KMJ Chan
Keyword(s):  
Thoracic Aorta ◽  
Open Repair ◽  
Aortic Disease ◽  
Thoracic Endovascular Aortic Repair ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Aortic Diseases ◽  
Thoracic Aortic Disease ◽  
Thoracic Aortic Aneurysms ◽  
Aortic Repair

Introduction The development of thoracic endovascular aortic repair has altered the approach and reduced the risk of treating the majority of descending thoracic aortic conditions. Primarily developed for the exclusion of thoracic aortic aneurysms, it is now used in place of open repair surgery for most descending thoracic aortic diseases, and has also been used to treat aortic arch diseases in selected cases. Methods A literature search was conducted of Medline and Embase databases from January 2007 to February 2017, using the key words ‘aortic disease’, ‘thoracic aorta’ and ‘endovascular repair’; 205 articles were identified, of which 25 studies were selected for review based on their relevance. Findings The key findings of the indications, techniques, outcomes, complications and comparisons with open surgical repair were extracted from the published studies and are summarised in this review. Thoracic endovascular aortic repair is the preferred choice of intervention for patients with descending thoracic aortic disease. With time, it has improved to be safer and has the potential to expand aortic treatment choices in future.

Thoracic Endovascular Aortic Repair in the Ascending Aorta

2015 ◽  
Vol 10 (5) ◽  
pp. 363-367 ◽  
Author(s):  
Anja Muehle ◽  
Aamir Shah ◽  
Ali Khoynezhad
Keyword(s):  
Treatment Options ◽  
Aortic Disease ◽  
Ascending Aorta ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Attractive Alternative ◽  
Aortic Repair ◽  
Alternative Treatment Option ◽  
Risk Patients ◽  
Aortic Pathologies

Thoracic endovascular aortic repair has become an attractive alternative treatment option for thoracic aortic disease. New devices and advanced image-guided procedures are continuously expanding the indications. This article focuses on technical aspects of transapical stent graft deployment for ascending aortic pathologies. With improving device technology, diverse available stent grafts, and imaging modalities, thoracic endovascular aortic repair has become safer and holds promising potential to expand treatment options, especially for high-risk patients requiring ascending aorta treatment.

scholarly journals PC076. Thoracic Sarcopenia Is a Specific Predictor of Late Mortality After Thoracic Endovascular Aortic Repair in Patients With Chronic Aortic Disease

2018 ◽  
Vol 67 (6) ◽  
pp. e195-e196
Author(s):  
Sydney Olson ◽  
Annalise Panthofer ◽  
Donald Harris ◽  
William D. Jordan ◽  
Mark A. Farber ◽  
...  
Keyword(s):  
Aortic Disease ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Late Mortality ◽  
Aortic Repair

scholarly journals Outcome after cervical debranching for proximal landing zone extension in thoracic endovascular aortic repair

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
V Makaloski ◽  
E Lutz ◽  
R Bühlmann ◽  
S Weiss ◽  
J Schmidli
Keyword(s):  
Nerve Injury ◽  
Cranial Nerve ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Safe Procedure ◽  
Long Term Outcome ◽  
Landing Zone ◽  
Postoperative Stroke ◽  
Aortic Repair

Abstract Objective Aim of this study was to assess perioperative and long-term outcome after cervical debranching for proximal landing zone extension in thoracic endovascular aortic repair (TEVAR). Methods Retrospective analysis of all patients undergoing left-sided carotid-subclavian bypass (CSB) and subclavian-carotid transposition (SCT) with simultaneous or staged TEVAR between 2010 and 2019. Endpoints were patency and re-intervention due to the debranching, postoperative stroke, cranial nerve injury and mortality at 30 days and during follow-up. Results Forty-eight patients (66 ± 12 years, 81 % male) had 25 (52%) CSB and 23 (48%) SCT. TEVAR was performed simultaneously in 39 (81%). Eleven (23%) patients had simultaneous emergency debranching and TEVAR. There were eight (17%) re-interventions within 30 days: four due to local hematoma, one for bypass occlusion, two for stenosis (of which one was not confirmed intraoperatively), and one after initially abandoned SCT with subsequent CSB on the next day. Thirty-day mortality was 2 %; one patient died on the first postoperative day after combined CABG surgery and multiorgan failure. Four (8%) patients suffered postoperative strokes; three occurred after simultaneous emergency procedures and none was fatal. Seven (15%) patients had postoperative ipsilateral cranial nerve lesions: two occurred after CSB and five after SCT. Two patients had recurrent laryngeal nerve palsy, two had phrenic nerve injury and three had Horner syndrome. All patients had mild symptoms and recovered mostly. During a mean follow-up of 31±29 months with a Follow-up Index of 0.77, there were no reinterventions or occlusions, and no graft infections. Primary patency was 94%, primary assisted patency 96%, and secondary patency 100%. 9 patients died during follow-up after a mean of 30±29 months (range 0-82) all of them with patent cervical debranching. Conclusion Cervical debranching for proximal landing zone extension in TEVAR is a safe procedure with an acceptable rate of early re-interventions. There is a higher risk for postoperative stroke during simultaneous emergency debranching and TEVAR. Cranial nerve injuries and hematomas remain relevant periprocedural complications. During follow-up, excellent patency can be expected.

Aortic disease: thoracic endovascular aortic repair

Heart ◽  
2015 ◽  
Vol 101 (8) ◽  
pp. 586-591 ◽  
Author(s):  
Colin Bicknell ◽  
Janet T Powell
Keyword(s):  
Aortic Disease ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair
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