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Review
. 2023 Feb 24;20(5):4094.
doi: 10.3390/ijerph20054094.

Endovascular Intervention for Aortic Dissection Is "Ascending"

Antonio Rizza  1 , Francesco Negro  2 , Tim J Mandigers  3 , Cataldo Palmieri  1 , Sergio Berti  1 , Santi Trimarchi  3   4
Affiliations
Review

Endovascular Intervention for Aortic Dissection Is "Ascending"

Antonio Rizza et al. Int J Environ Res Public Health. .

Abstract

Ascending aorta diseases represent an important cause of mortality worldwide. Notably, acute and chronic thoracic aorta pathologies have increased during the last years, but medical therapy does not seem to influence their natural history. Currently, although open surgery is the first choice of treatment, many patients are still rejected or have poor outcomes. In this scenario, endovascular treatment is raised as a valuable option. In this review we describe the limitations of conventional surgery and the state-of-art of endovascular ascending aorta repair.

Keywords: aortic aneurysm; aortic disease; aortic dissection; atherosclerosis; percutaneous intervention.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A–D) Computed tomography angiogram of a patient with type A aortic dissection: axial scan (A), coronal scan (B), sagittal scan (C) and 3D volume rendering view. AoV = aortic valve; DAo = descending aorta; DF = dissection flap; FL = false lumen; TL = true lumen.
Figure 2
Figure 2
Real picture of type A aortic dissection surgical repair after sternotomy.
Figure 3
Figure 3
Representation of type A aortic dissection treated with a too long endoprosthesis, covering supra-aortic vessel origins. Red circle indicates supra-aortic vessel covering by the endoprosthesis. BCT = brachiocephalic trunk; FL = false lumen; LCCA = left common carotid artery; LMCA = left main coronary artery; LSA = left subclavian artery; RCA = right coronary artery.
Figure 4
Figure 4
Representation of type A aortic dissection treated with a too short endoprosthesis that does not cover aortic dissection. Blue circle indicate the areas of dissection uncovered by endoprosthesis. BCT = brachiocephalic trunk; FL = false lumen; LCCA = left common carotid artery; LMCA = left main coronary artery; LSA = left subclavian artery; RCA = right coronary artery.
Figure 5
Figure 5
(A,B) Representation of inner and outer curves of ascending aorta in volume rendering 3D computed tomography angiogram. Inner curve (A) appears shorter than outer curve (B).
Figure 6
Figure 6
Real picture of Bentall intervention for type A aortic dissection complicated by aortic valve regurgitation, showing ascending aorta resection and aortic valve exposure.
Figure 7
Figure 7
Figure reporting the step-by-step procedure published by Gaia in 2020. First, a femoral arterial access for angiography and femoral venous access for pacing are obtained; RCA and LMCA are cannulated; then a transapical access with a 30 Fr introducer is obtained; consequently, endoprosthesis is positioned and deployed; after that, balloon expandable prosthetic aortic valve is deployed. Then, RCA and LMCA are cannulated through endoprosthesis main body and coronary branches and connecting stents are finally deployed. Courtesy of Professor Diego Gaia, Federal University of Saõ Paulo, Brazil. LMCA = left main coronary artery; RCA = right coronary artery.
See this image and copyright information in PMC

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