Key result
Thoracic endovascular aortic repair effectively treats descending aortic pathologies but faces ongoing challenges including retrograde type-A dissection, endoleaks, and spinal cord ischemia.
Why the study?
Despite significant progress in thoracic endovascular aortic repair (TEVAR) technology, limitations and challenges remain in treating various aortic pathologies, including a lack of appropriate stent grafts specifically designed for acute dissections.
While TEVAR has revolutionized the treatment of thoracic aortic pathologies, ongoing technological advancements are required to address device limitations and mitigate severe complications such as retrograde dissection and spinal cord ischemia.
TEVAR remains standard for descending aortic disease despite risks; leaves open the need for device innovations to reduce complications.
In 1987 Nikolay Volodos performed the world's first endovascular treatment of aortic aneurysms. Endovascular technology has progressed significantly since then. There are now many thoracic endovascular aortic repair (TEVAR) systems commercially available. By applying them, we can treat many pathologies: aneurysms, dissections, aortic ruptures, and penetrating aortic ulcers. However, TEVAR technology still has its limitations, namely the risk of a retrograde type A dissection, the issue of precise landing in the distal landing zone, and the risk of air embolism and paraplegia. Furthermore, there are no appropriate stent grafts widely available to treat acute dissections. Those currently used are designed for aneurysms, not for dissections. As a result, there are several challenges facing the future TEVAR surgical community, such as the need to develop new and more precise systems with retrograde deployment for the distal landing zone, as well as to introduce flexible stent grafts to treat dissections. The endo-Bentall is being developed as an alternative treatment method for acute type-A aortic dissection.
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Juraszek et al. (2022) conducted a review in Thoracic aortic pathologies. Thoracic endovascular aortic repair (TEVAR) was evaluated. Thoracic endovascular aortic repair effectively treats descending aortic pathologies but faces ongoing challenges including retrograde type-A dissection, endoleaks, and spinal cord ischemia.
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