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Online ISSN 1827-1847
NEW DEVELOPMENTS IN TREATMENT OF THE AORTIC ARCH AND AORTIC DISSECTIONS
Lisy M., Stelter W. J., Kalender G.
Department of General, Visceral, Thoracic and Vascular Surgery, Frankfurt‑Höchst City Hospital, Frankfurt, Germany
Aortic dissection is accompanied with one of the highest mortality rates in cardiovascular disease. Conventional treatment for the acute aortic type A dissection remains surgical replacement requiring cardiopulmonary bypass and in cases of involved aortic arch pathologies also moderate to deep hypothermic circulatory arrest with selective brain perfusion. Reported mortality rates range from 7% to 17% and stroke rates from 4% to 12%. The general evolution of endovascular technologies have resulted in a significant reduction of perioperative mortality and morbidity compared to traditional open surgery of descending and abdominal aortic diseases. Currently, combined open and endovascular treatment (hybrid procedures) have become the preferred approach even in thoraco-abdominal pathologies. The management of ascending aorta and aortic arch with TEVAR (thoracic endovascular repair) using fenestrated and branched devices remains a clinical challenge. Specific anatomic issues as well patient comorbidity play crucial roles in the decision making for these novel treatment modalities.