Combined Endovascular Treatment of Complex Aortic Pathologies
Levent Mavioglu1, Hakki Zafer Iscan1, Goktan Askin1
1Department of Cardiovascular Surgery, Ankara City Hospital, Cankaya, Turkey.
The Thoracic and Cardiovascular Surgeon
|July 18, 2023
Summary
Simultaneous endovascular repair of thoracic and abdominal aortic pathologies offers a rapid, less-invasive option with good early and midterm outcomes. This approach is a viable alternative to staged or hybrid therapies for suitable patients.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Endovascular Interventions
Background:
- Multisegmented aortic pathologies pose significant treatment challenges.
- Both open and endovascular approaches have distinct advantages and disadvantages.
- Simultaneous repair strategies are being explored for complex aortic disease.
Purpose of the Study:
- To evaluate the early and midterm outcomes of simultaneous endovascular thoracic and abdominal aortic repair.
- To assess the feasibility and safety of this combined endovascular approach.
- To compare this strategy with staged or hybrid repair methods.
Main Methods:
- Retrospective analysis of 16 patients undergoing simultaneous endovascular repair for thoracic aortic pathology and infrarenal abdominal aortic aneurysm (iAAA).
- Procedures performed between January 2016 and January 2021 by a single cardiovascular surgeon team.
- Data collected on technical success, morbidity, mortality, and need for secondary interventions.
Main Results:
- 100% technical success rate with no early mortality observed.
- Average follow-up of 21.85 months; 84.6% first-year survival.
- Two patients required secondary interventions; no aneurysm-related mortality.
- Short intensive care unit stays and hospital lengths of stay were noted.
Conclusions:
- Simultaneous endovascular repair is a safe and effective approach for complex multisegmented aortic pathologies.
- This strategy offers a rapid, less-invasive alternative to staged and hybrid therapies.
- Careful monitoring for contrast-induced nephropathy, postimplantation syndrome, and spinal cord ischemia is recommended.
Related Concept Videos
01:26Aneurysm III: Interprofessional Care
10
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
10
01:25Aortic Regurgitation III: Medical Management
25
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
25
01:27Peripheral Artery Disease III: Interprofessional Care
11
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
11
01:18Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists
202
Endothelins (ETs) are potent vasoactive peptides critical in the human body's various physiological and pathological processes. One of the most promising therapeutic strategies for treating pulmonary arterial hypertension (PAH) involves counteracting the effects of these endothelins using a class of drugs known as endothelin receptor antagonists.
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
202
01:29Venous Thrombosis III: Interprofessional Care
10
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
10