Abstract
Open surgery remains the mainstay of treatment for acute type A aortic dissection and should be offered to most patients. However, there are elderly patients in which surgical treatment may be deemed extremely high risk or futile. Endovascular treatment approaches have been applied to a small number of these patients and data are limited to case reports and small series. The application of endovascular therapies to ascending aorta is currently limited by anatomical and technical challenges posed by the dynamic motion of the ascending aorta and the proximity of vital structures to intended landing zones (aortic valve, coronary arteries, and supra-aortic branches) and lack of specially designed endografts to address these issues. While thoracic endovascular aortic repair (TEVAR) has replaced open aortic repair for a suitable lesion in distal aortic dissection, some selected patients with type A aortic dissection at high surgical may be candidates. Hence, there is potential because, in proximal (Stanford type A) dissections, 10–30% of patients are not accepted for surgery, and 30–50% are technically amenable for TEVAR. Recent experience has shown that carefully selected patients with favorable anatomical characteristics may be subject to endovascular stent-graft treatment as a last resort with mixed results. Technical improvement is necessary to offer. satisfactory endovascular options in non-surgical candidates.
Highlights
Acute type A aortic dissection (TAAD) is a surgical emergency with high morbidity and mortality
Stroke occurred in three of 45 patients (6.8%)—two of which had received their stents via left common carotid artery approach [7, 8]. Another important characteristic relates to the design of stent-graft; devices without proximal bare springs are recommended to avoid compromising of the aortic valve
The mortality rate at 1-year follow-up was noted 0 to 28.3%, while the endoleak occurred and re-intervention required after thoracic endovascular aortic repair (TEVAR) are 0–27.3% and 0–33.3%, retrospectively (Table 1)
Summary
Acute type A aortic dissection (TAAD) is a surgical emergency with high morbidity and mortality. Stroke occurred in three of 45 patients (6.8%)—two of which had received their stents via left common carotid artery approach [7, 8] Another important characteristic relates to the design of stent-graft; devices without proximal bare springs are recommended to avoid compromising of the aortic valve. The stent-graft was delivered over the stiff guidewire to its intended position, where its distal landing zone is between distal to coronary ostia and proximal to brachiocephalic artery in the ascending aorta. In this position, the distal tip of the delivery system may cross the aortic valve. The mortality rate at 1-year follow-up was noted 0 to 28.3%, while the endoleak occurred and re-intervention required after TEVAR are 0–27.3% and 0–33.3%, retrospectively (Table 1)
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