Scholarlink

<p>Thoracic endovascular aortic repair (TEVAR) is the standard treatment for pathologies in the distal aortic arch and descending aorta. In up to 50% of cases a landing in Ischimaru zone&#xa0;2 is necessary to achieve a&#xa0;safe seal, whereby perfusion of the left subclavian artery (LSA) should be maintained to prevent stroke and ischemia. For revascularization of the LSA open surgical procedures, such as a carotid-subclavian/axillary bypass and LSA transposition as well as endovascular approaches, such as branched (bTEVAR) and fenestrated endoprostheses (fTEVAR) are available. Endovascular techniques include custom made (CMD), off the shelf and physician-modified devices (PMD), with the latter being subdivided into ex situ and in situ modifications. Another method is the parallel graft technique. The choice of technique depends on the anatomy of the patient, the technical possibilities and the expertise of the surgeon/interventionalist. The bTEVAR prostheses are technically demanding and often require additional manipulation. The fTEVAR prostheses require a&#xa0;closer alignment to the aortic wall and therefore necessitate a&#xa0;greater distance from the aortic pathology. The CMD prostheses offer maximum precision but are expensive and not always available. Off the shelf and PMD prostheses offer more flexibility, whereby PMDs require special expertise and equipment. The parallel graft technique is used as a&#xa0;bailout strategy. Future developments are aimed at standardized, more cost-effective solutions but long-term results are still lacking. Larger studies are needed to determine the optimal technique. This article provides an overview of current endovascular debranching techniques for LSA and discusses the advantages and disadvantages.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Endovaskuläre Techniken zur Erhaltung der linken Arteria subclavia im Rahmen von TEVAR in Zone 2

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年1月8日

查看全文
  • Benedikt Reutersberg,
  • Lorenz Meuli,
  • Anna-Leonie Menges,
  • Alexander Zimmermann

摘要

Thoracic endovascular aortic repair (TEVAR) is the standard treatment for pathologies in the distal aortic arch and descending aorta. In up to 50% of cases a landing in Ischimaru zone 2 is necessary to achieve a safe seal, whereby perfusion of the left subclavian artery (LSA) should be maintained to prevent stroke and ischemia. For revascularization of the LSA open surgical procedures, such as a carotid-subclavian/axillary bypass and LSA transposition as well as endovascular approaches, such as branched (bTEVAR) and fenestrated endoprostheses (fTEVAR) are available. Endovascular techniques include custom made (CMD), off the shelf and physician-modified devices (PMD), with the latter being subdivided into ex situ and in situ modifications. Another method is the parallel graft technique. The choice of technique depends on the anatomy of the patient, the technical possibilities and the expertise of the surgeon/interventionalist. The bTEVAR prostheses are technically demanding and often require additional manipulation. The fTEVAR prostheses require a closer alignment to the aortic wall and therefore necessitate a greater distance from the aortic pathology. The CMD prostheses offer maximum precision but are expensive and not always available. Off the shelf and PMD prostheses offer more flexibility, whereby PMDs require special expertise and equipment. The parallel graft technique is used as a bailout strategy. Future developments are aimed at standardized, more cost-effective solutions but long-term results are still lacking. Larger studies are needed to determine the optimal technique. This article provides an overview of current endovascular debranching techniques for LSA and discusses the advantages and disadvantages.