REVIEW  RECENT DEVELOPMENTS IN THE MANAGEMENT OF AORTIC DISSECTIONS 

The Journal of Cardiovascular Surgery 2018 December;59(6):775-83

DOI: 10.23736/S0021-9509.18.10579-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Frozen elephant trunk and arch endografts for chronic thoracoabdominal aortic dissections

Giovanni TINELLI ¹, Marco FERRARESI ¹, A. Claire WATKINS ^{2, 3}, Raphael SOLER ², Elie FADEL ², Dominique FABRE ², Stéphan HAULON ² ✉

¹ Unit of Vascular Surgery, Center for Cardiovascular and Thoracic Surgery, Policlinico A. Gemelli University Foundation, Rome, Italy; ² Aortic Center, Marie Lannelongue Hospital, Le Plessis Robinson, Paris Sud University, Paris, France; ³ Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA

Chronic aortic dissecting aneurysms (TAAD) presenting after acute Stanford type A or B dissection includes both arch and/or thoracoabdominal aortic aneurysms (TAAA). Approximately 60% of patients who survive surgical treatment of acute type A aortic dissections will require another aortic procedure. Similarly, more than 70% of patients with chronic type B aortic dissections will experience false lumen dilation at 5-year follow-up, often requiring intervention. Open or hybrid aortic repairs of complex TAAD involving the arch and the TAAA are very demanding procedures for both patients and clinicians. Open surgery remains the first line therapy in fit patients. Recent development of branched arch devices has offered an alternative option for high-risk patients. Technical challenges associated with the endovascular management of these complex aneurysms include proximal sealing zone often located in the aortic arch or the ascending aorta, narrow true lumen working space, and aortic branch perfusion by either the true or false lumen, or both. Recent studies have reported encouraging results with endovascular treatment of these complex dissecting aneurysms, especially following open ascending aortic repair. The aim of this review was to describe the available strategies for arch repair in the setting of a chronic TAAD and to determine the subset of patients that can benefit from of a totally endovascular approach.

KEY WORDS: Aorta - Aneurysm - Dissection