Endovascular Treatment of Chronic Aneurysmal Aortic Dissection: In Search of Effective Repairs

Abstract

Management of aneurysms in the setting of chronic Type B aortic dissections still represents one area that leaves much to be desired. As the authors and others have pointed out, 20–50% of dissection patients will have aneurysmal degeneration with up to 40% of medically managed patients requiring an intervention and two-thirds of those due to aneurysmal degeneration. 1 Durham C.A. Aranson N.J. Ergul E.A. et al. Aneurysmal degeneration of the thoracoabdominal aorta after medical management of type B aortic dissection. J Vasc Surg. 2015; 62: 900-906 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar Traditional open surgery is not an easy feat for both the patient and operator with high complication rates. 2 Conrad M.F. Crawford R.S. Davison J.K. et al. Thoracoabdominal aneurysm repair: a 20-year perspective. Ann Thorac Surg. 2007; 83: S856-S861 Abstract Full Text Full Text PDF PubMed Scopus (297) Google Scholar Much effort has been spent searching for an acceptable endovascular solution to this problem but these suffer from both a lack of the necessary technology and the technically demanding nature of the case. Many of the challenges to endovascular treatment stem from the dual lumens, multiple entry points, lack of distal seal zones, and difficult access and angles to the visceral vessels. 3 Kuzniar M.K. Wanhainen A. Tegler G. et al. Endovascular treatment of chronic aortic dissection with fenestrated and branched stent grafts. J Vasc Surg. 2021; 73: 1573-1582 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Treatment of thoracoabdominal aortic aneurysmal degeneration following aortic dissections at a single surgical center using a physician-assembled branched endovascular stent graftAnnals of Vascular SurgeryPreviewAneurysmal degeneration of aortic dissection portends significant morbidity and mortality consequences in the subacute and chronic phases of aortic dissection. This paper describes the use of a multi-branched stent graft system for the treatment of thoracoabdominal aneurysmal degeneration of dissections with visceral segment involvement and reports upon the 30-day and one-year outcomes for the first 18 patients treated with this design configuration. Full-Text PDF