This Article Full Text (PDF) All Versions of this Article: 1089253208328667v1 1089253208328667v2 12/4/298    most recent References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Hughes, G. C. Articles by Swaminathan, M. Search for Related Content PubMed PubMed Citation Articles by Hughes, G. C. Articles by Swaminathan, M. Social Bookmarking                         What's this?

Endovascular Approaches to Complex Thoracic Aortic Disease

Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, gchad.hughes{at}duke.edu

Christopher F. Sulzer, MD

Service d'Anesthesiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Richard L. McCann, MD

Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina

Madhav Swaminathan, MD, FASE, FAHA

Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina

Diseases of the thoracic aorta remain among the most lethal and difficult to treat conditions. In 2005, the US Food and Drug Administration approved the first endoprosthesis for the treatment of aneurysms of the descending thoracic aorta; at present, there are 3 thoracic devices approved by the US Food and Drug Administration. Although approved only for the treatment of descending aneurysms, thoracic endografting has other potential off-label applications, including acute and chronic aortic dissection and traumatic aortic transection. Endovascular repair of thoracic aortic pathology is emerging as the preferred treatment strategy in certain patients, as increasing data suggest that endovascular repair may be performed with lower peri-operative morbidity and mortality rates and similar midterm survival, when compared with standard open repair. However, because of anatomic constraints related to required endograft seal zones, a significant number of patients are excluded from standard endovascular repair. Hybrid techniques, including open aortic arch and thoracoabdominal debranching procedures, have been described to allow creation of proximal and/or distal landing zones for the stent graft seal. This review describes the surgical and anesthetic considerations relevant to thoracic endografting, with an emphasis on hybrid procedures used to treat more complex thoracic aortic pathology. Hybrid techniques may be performed with lower rates of morbidity and mortality than conventional open repair, and they appear to be a safe alternative to open repair for thoracoabdominal and aortic arch aneurysms in properly selected patients with significant comorbidity or prior open aortic surgery.

Key Words: aneurysm • aorta/aortic • aortic operation • endovascular procedures/stents

This version was published on December 1, 2008

Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 12, No. 4, 298-319 (2008)
DOI: 10.1177/1089253208328667


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. Swaminathan Thinking From Inside the Box Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2008; 12(4): 225 - 227. [PDF]