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<p>On average 11.5% of patients undergo revision surgery of the aorta within the first 4.7&#xa0;years after the primary replacement of the ascending aorta or the aortic arch. Open surgical repair of the aortic arch remains the gold standard but only for a&#xa0;highly selected group of patients. The two main indications for these interventions are postdissection aneurysms and de novo aortic aneurysms. A prosthesis infection is a rarer indication for aortic revision surgery. Patients requiring a revision operation are significantly older and are five times more likely to have an underlying coronary artery disease. Open revision surgery with involvement of the aortic arch is technically very demanding due to the renewed sternotomy and adhesion-related complexity and is responsible for a&#xa0;higher 30-day mortality (5–23%) and major complications, such as stroke (5–18%); however, endovascular revision surgery of the aortic arch is associated with a&#xa0;lower 30-day mortality (0–5%) and postoperative stroke rate (0–5%) and demonstrated a&#xa0;technical feasibility of up to 97% for all available stent grafts. Due to the low invasiveness and wide range of indications endovascular revision surgery is an accepted alternative for selected patients and represents a&#xa0;major challenge; however, the endovascular treatment of the aortic arch is associated with a&#xa0;high rate of early reinterventions. The decision on which procedure (open vs. endovascular revision) should be used depends on many factors. The decision should ideally be discussed in an interdisciplinary aortic board in which all factors are taken into account and the individual risks of each procedure are weighed up in comparison to each other.</p>

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Offene Operation vs. endovaskuläres Bogenrepair bei Revisionsoperationen des Aortenbogens

  • 期刊论文

  • 发表日期：

    2025年1月7日

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  • Abdulhakim Ibrahim,
  • Miroslav Dimitrov Yordanov,
  • Andreas Rukosujew,
  • Alexander Oberhuber

摘要

On average 11.5% of patients undergo revision surgery of the aorta within the first 4.7 years after the primary replacement of the ascending aorta or the aortic arch. Open surgical repair of the aortic arch remains the gold standard but only for a highly selected group of patients. The two main indications for these interventions are postdissection aneurysms and de novo aortic aneurysms. A prosthesis infection is a rarer indication for aortic revision surgery. Patients requiring a revision operation are significantly older and are five times more likely to have an underlying coronary artery disease. Open revision surgery with involvement of the aortic arch is technically very demanding due to the renewed sternotomy and adhesion-related complexity and is responsible for a higher 30-day mortality (5–23%) and major complications, such as stroke (5–18%); however, endovascular revision surgery of the aortic arch is associated with a lower 30-day mortality (0–5%) and postoperative stroke rate (0–5%) and demonstrated a technical feasibility of up to 97% for all available stent grafts. Due to the low invasiveness and wide range of indications endovascular revision surgery is an accepted alternative for selected patients and represents a major challenge; however, the endovascular treatment of the aortic arch is associated with a high rate of early reinterventions. The decision on which procedure (open vs. endovascular revision) should be used depends on many factors. The decision should ideally be discussed in an interdisciplinary aortic board in which all factors are taken into account and the individual risks of each procedure are weighed up in comparison to each other.