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The 3-step approach for the treatment of multisegmental thoraco-abdominal aortic pathologies

Tim Berger1,2, Maximilian Kreibich1,2, Bartosz Rylski1,2

  • 1Department of Cardiovascular Surgery, University Heart Centre Freiburg University, Freiburg, Germany.

Interactive Cardiovascular and Thoracic Surgery
|March 6, 2021
PubMed

Insights

This study presents a novel 3-step approach for treating complex aortic dissection, combining open and endovascular techniques for excellent outcomes and low risk in multisegmental thoraco-abdominal aortic disease.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Aortic Disease Management

Background:

  • Multisegmental thoraco-abdominal aortic disease due to aortic dissection presents complex treatment challenges.
  • Previous aortic surgeries often complicate management of recurrent or extensive dissections.

Purpose of the Study:

  • To describe a novel 3-step treatment strategy for multisegmental thoraco-abdominal aortic disease resulting from aortic dissection.
  • To report initial clinical outcomes and perioperative risks associated with this approach.

Main Methods:

  • A 3-step hybrid approach was employed, including total aortic arch replacement (frozen elephant trunk), thoracic endovascular aortic repair (TEVAR), and open thoraco-abdominal aortic replacement.
  • Nine patients with complex aortic pathology underwent this staged intervention.

Main Results:

  • The study included nine patients with a median age of 58 years; 44% had connective tissue disease and 89% had prior aortic surgery.
  • Zero in-hospital mortality and no cases of spinal cord injury or disabling stroke were observed.
  • One late death occurred due to unrelated sepsis 6 months post-procedure.

Conclusions:

  • The described 3-step hybrid approach for multisegmental thoraco-abdominal aortic disease in aortic dissection is associated with excellent clinical outcomes.
  • This strategy offers a low perioperative risk, potentially by limiting the extent of open thoraco-abdominal aortic repair through distal disease management with TEVAR.
Abstract

Keywords:
Frozen elephant trunk techniqueMultisegmental thoraco-abdominal aortic pathologyResidual aortic dissectionThoracic endovascular aortic repairThoraco-abdominal aortic replacementThree-step approach

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