REVIEW   

Italian Journal of Vascular and Endovascular Surgery 2018 December;25(4):332-8

DOI: 10.23736/S1824-4777.18.01361-X

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Fenestrated and branched endovascular aneurysm repair outcomes for type II and III thoracoabdominal aortic aneurysm

Adam TANIOUS, Srihari LELLA, Ann S. ADAMS, Matthew J. EAGLETON ✉

Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA

Open repair of large, anatomically-complex extent II and III thoracoabdominal aortic aneurysms is associated with significant morbidity and mortality compared with less extensive disease (extent I and IV), even at highly specialized centers. However, rapid advances in endovascular technology in recent decades have resulted in significantly improved outcomes for extent II and III repairs. Although the decision to treat by open or endovascular means continues to be debated, subsets of patients clearly benefit from an endovascular approach, including patients over 75 years of age, those with significant chronic obstructive pulmonary disease, and those with symptomatic or ruptured TAAAs. This review highlights the options and outcomes of patients with extensive type II and III TAAAs treated by endovascular means, focusing on fenestrated and branched technology. The evolution and efficacy of off-the-shelf versus purpose-built endovascular devices and the emerging hybridization of these two approaches is also explored. Despite initial reluctance, the global vascular community has adopted an endovascular-first mentality for most aortic pathologies. Future considerations will focus on accessibility, feasibility, and healthcare costs.

KEY WORDS: Thoracic aortic aneurysms - Thoracic aorta - Endovascular procedures - Vascular grafting - Chronic obstructive pulmonary disease