K. Meisenbacher

Device Conformability and Morphological Assessment After TEVAR for Aortic Type B Dissection: A Single-Centre Experience with a Conformable Thoracic Stent-Graft Design.

Background The aim of this study was to analyze device conformability in TEVAR of acute and chronic (a/c) type B aortic dissections (TBAD) using the Gore Conformable Thoracic Aortic Stent-graft (CTAG). Material/Methods From January 1997 to February 2014, a total of 90 out of 405 patients in our center received TEVAR for TBAD. Since November 2009, 23 patients (16 men; median age: 62 years) were treated with the CTAG. Indications were complicated aTBAD in 15 (65%) and expanding cTBAD in 8 (35%) patients. Primary endpoints were the assessment of device conformability by measuring the distance (D) from the radiopaque gold band marker (GM) at the proximal CTAG end to the inner curvature (IC) of the arch on parasagittal multiplanar reformations of CT angiography, as well as the evaluation of aortic diameter changes following TEVAR. Median follow-up was 13.3 months (range: 2 days to 35 months). Results Primary and secondary success rates were 91.3% (21/23) and 95.6% (22/23), respectively. There was 1 type Ia endoleak, retrograde dissection or primary conversion was not observed. Median GM-IC-D was 0 mm (range: 0 mm to 10 mm). GM-IC-D was associated with zone 2 placement compared to zone 3 (P=0.036). There was no association between GM-IC-D formation and arch type. In aTBAD cases the true lumen significantly increased after TEVAR (P=0.017) and the false lumen underwent shrinkage (P=0.025). In cTBAD patients the false lumen decreased after TEVAR (P=0.036). Conclusions The CTAG shows favorable conformability and wall apposition in challenging arch pathologies such as TBAD.

Type IIIb Endoleak after Thoracic Endovascular Aortic Repair Caused by Endoanchor Dislocation

BACKGROUND The aim of this study was to report the occurrence of a type IIIb endoleak after endovascular repair of a thoracic aortic aneurysm caused by endoanchor dislocation. CASE REPORT An 84-year-old female patient underwent thoracic endovascular repair for aneurysmal disease of her thoracic aorta. The procedure included primary left subclavian artery revascularization and the placement of endoanchors to enhance fixation of the endograft within the aortic arch. Dislocation of one of the endoanchors resulted in a graft defect leading to a type IIIb endoleak and aortic diameter expansion. CONCLUSIONS Endoanchors represent a promising adjunct in endovascular repair settings. However, their use requires careful procedure planning and special attention during follow-up.

Erratum zu: Endovaskuläre Therapie genetisch bedingter Aortenerkrankungen

ZusammenfassungHintergrundDie wichtigsten Strukturproteine der Gefäßwand sind Kollagen und Elastin. Genetisch bedingte Bindegewebserkrankungen führen zu Degeneration und Aneurysmabildung, spontanen Dissektionen oder Rupturen von Arterien. Am bekanntesten sind das Marfan-Syndrom, das Ehlers-Danlos-Syndrom vom vaskulären Typ, das Loeys-Dietz-Syndrom sowie familiäre Aortenaneurysmen und Dissektionen.FragestellungWelchen Stellenwert haben endovaskuläre Behandlungsoptionen in der Therapie aortaler Pathologien auf dem Boden von Bindegewebserkrankungen?Material und MethodenAuswertung aktueller randomisierter Untersuchungen und Registerstudien.ErgebnisDie Therapie der Wahl der meist bereits in jungem Alter betroffenen Patienten ist primär konservativ bzw. offen-chirurgisch. Zur endovaskulären Therapie abdomineller Aneurysmen (EVAR) oder thorakalen Aortenpathologien (TEVAR) gibt es nur wenig Evidenz.SchlussfolgerungenDie Progression der genetisch bedingten Grunderkrankung mit konsekutiver Aortendilatation führt zu sekundären Endoleckagen und vermehrten Reinterventionen mit unsicherem Langzeitergebnis. Deshalb besteht derzeit Konsensus, dass EVAR und TEVAR bei genetisch bedingten Aortenerkrankungen auf begründete Ausnahmefälle und Notfallsituationen begrenzt sein sollten.