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The Journal of Cardiovascular Surgery 2014 August;55(4):505-17

Copyright © 2014 EDIZIONI MINERVA MEDICA

lingua: Inglese

Chronic dissection. Indications for treatment with branched and fenestrated stent-grafts

Sobocinski J. ¹, Spear R. ¹, Tyrrell M. R. ², Maurel B. ¹, Martin Gonzalez T. ¹, Hertault A. ¹, Midulla M. ¹, Azzaoui R. ¹, Haulon S. ¹ ✉

¹ Aortic Centre, Hôpital Cardiologique, CHRU Lille, France; ² St. Thomas’ Hospital, London, UK

The treatment of chronic aortic dissection is a major challenge for the vascular surgeon. Close imaging follow-up after the acute episode frequently identifies dilation of untreated aortic segments. Aortic dissection often extends to both the supra-aortic trunks and to the visceral aorta. The poor medical condition that often characterizes these patients may preclude extensive open surgical repair. Recent advances in endovascular techniques provide a valid alternative to open surgery. These complex lesions can now be managed using thoracic branched and fenestrated endografts. However, clinical data are scarce and only 3 small series from 3 high-volume aortic centers are currently available. Careful anatomical study on 3D workstations is mandatory to select patients that are candidates for complex endovascular exclusion; a specific focus on the available working space within the true lumen, extension to the arch and/or the visceral/renal arteries, and false lumen perfusion of visceral vessels is required. An excellent understanding of those anatomic details demands high-quality preoperative CTA. Intraoperative advanced imaging applications are a major adjunct in the achievement of technical success.