Endoluminale Rekonstruktion der aszendierenden Aorta mit Stentgrafts

Abstract

Aneurysms involving the ascending aorta have historically been treated with open surgical techniques requiring cardiopulmonary bypass and hypothermic circulatory arrest. Despite increasing experience and refinement of these procedures, there remains a substantial rate of mortality and morbidity, especially in the elderly. The invasiveness of the conventional procedure along with the associated risks have driven the cardiovascular community to explore other less invasive options. Experience gained from endovascular descending aortic aneurysm repair and recent advances in branch and fenestrated stent-grafts have permitted the treatment of more complex anatomy, which was previously considered contraindicated for endovascular repair. Considerations have been given to the ascending aorta, which poses unique challenges relating to of the potential for neurologic complications, the inherent arterial tortuosity, and the proximity of the aortic valve. A number of approaches have been developed to address some of the aforementioned concerns in a broad spectrum of proximal aortic disease and will be further explored in this article.