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Journal of Vascular and Endovascular Surgery 2009 June;16(2):91-100


language: English

Endovascular treatment of thoracic aortic pathologies: an 11-year single center experience

Geisbüsch P. 1, Schumacher H. 2, Kotelis D. 1, Hyhlik-Dürr A. 1, Von Tengg-Kobligk H. 3, Weber T. F. 4, Allenberg J. R. 1, Böckler D. 1

1 Department of Vascular and Endovascular Surgery Ruprecht-Karls University, Heidelberg, Germany 2 Department of Vascular Surgery, City Hospital Hanau Hanau, Germany 3 Department of Radiology German Cancer Research Center (DKFZ) Heidelberg, Germany 4 Department of Radiodiagnostics and Interventional Radiology Ruprecht-Karls University, Heidelberg, Germany


Since its introduction by Dake et al., more than 20 years ago, thoracic endovascular aortic repair (TEVAR) has been used with increasing frequency for a variety of different pathologies of the thoracic aorta. Although long-term data are still missing, TEVAR is well-established and has meanwhile replaced conventional open repair (OR) as the first treatment option in many vascular centers. This evolution is based on a minimal invasive approach associated with a potentially lower morbidity and mortality rate. Nevertheless, TEVAR bares several procedure specific complications (e.g. endoleak, stent-graft migration, material fatigue) and technical pitfalls which must be kept in mind while dealing with this treatment option. The aim of this paper was, therefore, to present the lessons learned in 11 years with thoracic endografting for different thoracic aortic pathologies focusing on applicability, results and device related problems. Over a period between January 1997 and September 2008 a total of 355 thoracic aortic stent-grafts were implanted in 221 patients (159 males, mean age 62 years ), 59% under emergency conditions. Indications included patients with atherosclerotic and post-traumatic aneurysms, aortic dissections, aortobronchial fistulas, and traumatic ruptures. Besides the morphological classification of thoracic aortic lesions, preoperative modern 3-D imaging for adequate procedure planning, current devices and their specific aspects during placement will be discussed. Furthermore, our own experience and results in selected indications will be presented. Thoracic endovascular reconstruction appears to be a safe and effective alternative to OR for many patients with thoracic aortic diseases, especially in emergencies. Prospective trials for individual diseases will be necessary to define its ultimate role.

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