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Review
. 2023 Mar 7;19(2):29-37.
doi: 10.14797/mdcvj.1173. eCollection 2023.

Endovascular Management of the Ascending Aorta: State of the Art

Aidan D Atkins  1 , Michael J Reardon  2 , Marvin D Atkins  2
Affiliations
Review

Endovascular Management of the Ascending Aorta: State of the Art

Aidan D Atkins et al. Methodist Debakey Cardiovasc J. .

Abstract

Endovascular stent graft repair (EVAR) has revolutionized the management of aneurysms and dissections of the thoracic and abdominal aorta and is considered the first-line treatment in such pathologies. Initially designed for patients unfit for open repair, EVAR and thoracic endovascular aortic stent graft repair are associated with improved morbidity and mortality and a faster recovery process. The endovascular revolution of the aorta continues moving proximally, with fenestrated and branch stent grafts currently in clinical trials for the management of thoracoabdominal aortic aneurysms, and several branched thoracic devices are either approved or in trial for management of aortic arch pathologies. The final frontier in the endovascular management of the aorta is the aortic root and ascending aorta. The first early feasibility trial for management of type A aortic dissection has recently concluded with a multicenter phase 2 study slated for the spring of 2023. The following article updates the reader on the unique challenges of endovascular management of the ascending aorta and a look at the future technologies that will define this space.

Keywords: ascending aortic aneurysm; ascending aortic dissection; ascending aortic stent graft; endovascular ascending repair.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Ishimaru classification scheme with five aortic landing zones
Figure 1
Ishimaru classification scheme with five aortic landing zones.
Gore Ascending Stent Graft. Reprinted with permission; GORE® ASCENDING STENT GRAFT © 2023. See Instructions for Use for complete device information, including approved indications and safety information
Figure 2
Gore Ascending Stent Graft. Reprinted with permission; GORE® ASCENDING STENT GRAFT © 2023. See Instructions for Use for complete device information, including approved indications and safety information.
Cook ascending graft, courtesy of Cook Medical
Figure 3
Cook ascending graft, courtesy of Cook Medical.
Terumo Aortic Relay Custom Medical Device
Figure 4
Terumo Aortic Relay Custom Medical Device. Used with permission from Terumo Medical Corporation.
Gore Ascending Stent graft implanted for type A aortic dissection. Reprinted with permission
Figure 5
Gore Ascending Stent graft implanted for type A aortic dissection. Reprinted with permission. GORE® ASCENDING STENT GRAFT © 2023. See Instructions for Use for complete device information, including approved indications and safety information.
The Bentall procedure
Figure 6
The Bentall procedure replaces aortic root and ascending aorta with reimplantation of the right and left coronary arteries as buttons.
See this image and copyright information in PMC

References

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