Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, OR.
Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland, OR.
Tech Vasc Interv Radiol. 2021 Jun;24(2):100754. doi: 10.1016/j.tvir.2021.100754. Epub 2021 Jul 26.
Open surgical repair of dissections and post-dissection degenerative aneurysms involving the ascending thoracic aorta and aortic arch, whether in the acute or post-repair state, is associated with high rates of morbidity and mortality. Recent advancements in minimally invasive endovascular techniques have expanded the role of thoracic endovascular aortic repair (TEVAR) for dissections and dissection-related arch pathologies. Image-guided endovascular techniques, such as in situ fenestrated grafts, chimney and/or periscope grafts, along with newly developed commercially available branched aortic devices, have allowed for an increasing number of high-risk operative candidates to undergo definitive repair of aortic arch pathology who otherwise would have been destined for non-operative management. This paper reviews the data, pre-procedural planning, and technical considerations for complex TEVAR techniques for ascending and aortic arch dissections and dissection-related aneurysms.
开放手术修复涉及升主动脉和主动脉弓的夹层和夹层后退行性动脉瘤，无论是在急性还是修复后状态，都与高发病率和死亡率相关。微创腔内技术的最新进展扩大了胸主动脉腔内修复术（TEVAR）在夹层和夹层相关弓部病变中的作用。影像引导的腔内技术，如原位开窗移植物、烟囱和/或潜望镜移植物，以及新开发的商业上可获得的分支主动脉器械，使越来越多的高危手术候选者能够接受主动脉弓部病变的确定性修复，否则他们将接受非手术治疗。本文回顾了用于升主动脉和主动脉弓夹层和夹层相关动脉瘤的复杂 TEVAR 技术的数据、术前规划和技术考虑因素。
