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. 2018 May;7(3):406-413.
doi: 10.21037/acs.2018.03.13.

Status of branched endovascular aortic arch repair

Theodorus M van Bakel  1   2   3 , Hector W de Beaufort  1   2 , Santi Trimarchi  2   4 , Massimiliano M Marrocco-Trischitta  2 , Jean Bismuth  5 , Frans L Moll  1 , Himanshu J Patel  6 , Joost A van Herwaarden  1
Affiliations

Status of branched endovascular aortic arch repair

Theodorus M van Bakel et al. Ann Cardiothorac Surg. 2018 May.

Abstract

Multiple medical device manufacturers are developing branched endografts for thoracic endovascular aortic repair (TEVAR), to provide a minimally invasive alternative for the treatment of aortic arch pathologies in patients who are deemed unfit for open or hybrid arch repair. Different branched endografts have been introduced, with varying number, size and orientation of the branches that redirect flow to the supra-aortic arteries. We present an overview of the currently investigated devices and review their outcomes. The results of branched TEVAR are promising, yet stroke remains the predominant periprocedural concern. For now, these procedures should be limited to select expert centers where the design and deployment procedure of branched endografts can be further developed to reduce the risk of stroke.

Keywords: Thoracic endovascular aortic repair (TEVAR); aortic arch repair; branched TEVAR; stent graft design.

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Conflict of interest statement

Conflicts of Interest: Prof. HJ Patel serves as consultant and co-patent holder with W.L. Gore and consultant for Medtronic Inc. and Terumo Inc.; Prof. S Trimarchi serves as consultant and speaker for W.L. Gore and Medtronic Inc.; Dr. JA van Herwaarden serves as consultant and speaker for Bolton Medical, Cook Medical and Philips Health Care; Dr. J Bismuth serves as consultant and speaker for W.L. Gore. All authors declare no conflicts of interest related to the contents of the manuscript.

Figures

Figure 1
Figure 1
Single-branched endografts. (A) NexusTM Stent Graft System for zone 0 from Endospan (Herzlia, Israel), this endograft is customizable with an additional fenestration for the left common carotid artery. Image provided courtesy of Endospan; (B) CastorTM branched endograft from MicroPort Medical Co., Ltd. (Shanghai, China), customizable with two additional fenestrations. Image provided courtesy of MicroPort Medical; (C) thoracic branch stent graft from Medtronic Vascular (Santa Rosa, CA, USA). Image provided courtesy of Medtronic Vascular; (D) GORE® TAG® thoracic endoprosthesis with retrograde internal branch from W.L. Gore (Flagstaff, AZ, USA). Image provided courtesy of W.L. Gore & Associates, Inc.
Figure 2
Figure 2
Multi-branched endografts. (A) Zone 0 endograft from Bolton Medical, permission for use was granted by Bolton Medical, Sunrise, Florida; (B) zone 0 endograft from Cook Medical, permission for use granted by Cook Medical, Bloomington, Indiana; (C) three versions of the Inoue Stent Graft from the PTMC institute (Kyoto, Japan), image from Tazaki et al. (12); (D) three component solution for zone 0 deployment from S&G Biotech, Inc. (Seongnam, Korea), image from Lim et al. (19).
See this image and copyright information in PMC

References

    1. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, A. Circulation 2010;121:e266-369. 10.1161/CIR.0b013e3181d4739e - DOI - PubMed
    1. Lioupis C, Abraham CZ. Results and challenges for the endovascular repair of aortic arch aneurysms. Perspect Vasc Surg Endovasc Ther 2011;23:202-13. 10.1177/1531003511413608 - DOI - PubMed
    1. Shrestha M, Beckmann E, Krueger H, et al. The elephant trunk is freezing: The Hannover experience. J Thorac Cardiovasc Surg 2015;149:1286-93. 10.1016/j.jtcvs.2015.01.044 - DOI - PubMed
    1. Marrocco-Trischitta MM, de Beaufort HW, Secchi F, et al. A geometric reappraisal of proximal landing zones for thoracic endovascular aortic repair according to aortic arch types. J Vasc Surg 2017;65:1584-90. 10.1016/j.jvs.2016.10.113 - DOI - PubMed
    1. Marrocco-Trischitta MM, van Bakel TM, Romarowski RM, et al. The Modified Arch Landing Areas Nomenclature (MALAN) Improves Prediction of Stent Graft Displacement Forces: Proof of Concept by Computational Fluid Dynamics Modelling. Eur J Vasc Endovasc Surg 2018;55:584-92. 10.1016/j.ejvs.2017.12.019 - DOI - PubMed