Aorta ascendens und Arcus aortae – endovaskuläre Therapie heute und in der Zukunft

Zusammenfassung

Pathologien im Bereich des Aortenbogens können isoliert auftreten, weit häufiger jedoch sind auch benachbarte Abschnitte der thorakalen Aorta – die Aorta ascendens oder Aorta descendens – mit betroffen. Die ersten operativen Eingriffe zur Behandlung des Aortenbogens wurden vor knapp 6 Jahrzehnten vorgenommen. Trotz zahlreicher Verbesserungen und Innovationen während des 20. und Anfang des 21. Jahrhunderts bleiben diese Eingriffe mit einer relevanten operativen Mortalität und neurologischen Komplikationsrate vergesellschaftet. Endovaskuläre Techniken sowie moderne Hybridverfahren erweitern das therapeutische Spektrum im Bereich des Aortenbogens zunehmend, auch wenn das offene operative Vorgehen aktuell noch der Goldstandard ist. Die endovaskuläre Behandlung eines Aortenaneurysmas wurde erstmals im Bereich der infrarenalen Aorta abdominalis in den frühen 1990er-Jahren durchgeführt. Es dauerte nicht lange, bis die ersten endovaskulären Therapieversuche zur Behandlung des Aortenbogens unternommen wurden. Schon 1996 berichteten Inoue et al. über den Einsatz der ersten gebranchten Endoprothese zur Behandlung von Aneurysmen im Aortenbogen. Fortwährende Verbesserungen und Verfeinerungen der Implantationstechniken und auch des implantierten Materials führten dazu, dass heutzutage im Bereich der deszendierenden thorakalen und abdominellen Aorta die endovaskuläre Therapie eine immer bedeutsamere Option im Vergleich zu den offenen chirurgischen Verfahren darstellt und diese teils als Goldstandard abgelöst hat. Diese Übersichtsarbeit soll einen Überblick über Voraussetzungen, Ergebnisse, aber auch Grenzen der endovaskulären Chirurgie des Aortenbogens geben.

Abstract

Pathologies in the region of the aortic arch may occur in isolation, but adjacent segments of the thoracic aorta – the ascending or descending aorta – are much more commonly affected. The first surgical procedures to treat the aortic arch were performed nearly six decades ago. Despite numerous improvements and innovations in the 20th and early 21st centuries, these procedures are still associated with relevant operative mortality and neurological complication rates. Endovascular techniques and modern hybrid procedures are increasingly expanding the therapeutic spectrum in the aortic arch, although the open surgical approach is currently still the gold standard. Endovascular treatment of aortic aneurysm was first performed in the early 1990s in the infrarenal abdominal aorta. It was not long before the first attempts at endovascular therapy were made for the treatment of the aortic arch. In 1996, Inoue et al. reported the use of the first commonly used endoprosthesis to treat aneurysms in the aortic arch. Continuous improvements and refinements in implantation techniques and also implanted material have resulted in endovascular therapy now being an increasingly important option compared to open surgical procedures in the descending thoracic and abdominal aorta and has partially replaced them as the gold standard. This review article aims to provide an overview of the prerequisites, results, but also limitations of endovascular surgery of the aortic arch.

Schlüsselwörter

Aorta thoracalis - Aortenchirurgie - Aortenaneurysma - endovaskuläre Therapie

Key words

aortic surgery - aortic stent prosthesis - aneurysm - endovascular treatment

Publication History

Article published online:
19 October 2021

• Literatur

• 1 Griepp RB, Stinson EB, Hollingsworth JF. et al. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg 1975; 70: 1051-1063
• 2 Pichlmaier M, Buech J, Tsilimparis N. et al. Routine Stent-Bridging to the Supraaortic Vessels in Aortic Arch Replacement – 10 year-experience. Ann Thorac Surg 2021; DOI: 10.1016/j.athoracsur.2021.05.074.
• 3 Patel HJ, Nguyen C, Diener AC. et al. Open arch reconstruction in the endovascular era: analysis of 721 patients over 17 years. J Thorac Cardiovasc Surg 2011; 141: 1417-1423 DOI: 10.1016/j.jtcvs.2011.02.020.
• 4 Hiraoka A, Chikazawa G, Tamura K. et al. Clinical outcomes of different approaches to aortic arch disease. J Vasc Surg 2015; 61: 88-95 DOI: 10.1016/j.jvs.2014.06.121.
• 5 Englum BR, He X, Gulack BC. et al. Hypothermia and cerebral protection strategies in aortic arch surgery: a comparative effectiveness analysis from the STS Adult Cardiac Surgery Database. Eur J Cardiothorac Surg 2017; 52: 492-498 DOI: 10.1093/ejcts/ezx133.
• 6 Smith HN, Boodhwani M, Ouzounian M. et al. Classification and outcomes of extended arch repair for acute Type A aortic dissection: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2017; 24: 450-459 DOI: 10.1093/icvts/ivw355.
• 7 Chakos A, Jbara D, Yan TD. et al. Long-term survival and related outcomes for hybrid versus traditional arch repair-a meta-analysis. Ann Cardiothorac Surg 2018; 7: 319-327 DOI: 10.21037/acs.2018.05.07.
• 8 Inoue K, Sato M, Iwase T. et al. Clinical endovascular placement of branched graft for type B aortic dissection. J Thorac Cardiovasc Surg 1996; 112: 1111-1113 DOI: 10.1016/S0022-5223(96)70115-0.
• 9 Tsilimparis N, Abicht JM, Stana J. et al. The Munich Valsalva Implantation Technique (MuVIT) for Cardiac Output Reduction During TEVAR: Vena Cava Occlusion With the Valsalva Maneuver. J Endovasc Ther 2021; 28: 7-13 DOI: 10.1177/1526602820961376.
• 10 Konstantinou N, Peterss S, Stana J. et al. Passing a Mechanical Aortic Valve With a Short Tip Dilator to Facilitate Aortic Arch Endovascular Branched Repair. J Endovasc Ther 2021; 28: 388-392 DOI: 10.1177/15266028211002506.
• 11 Kamman AV, de Beaufort HW, van Bogerijen GH. et al. Contemporary Management Strategies for Chronic Type B Aortic Dissections: A Systematic Review. PLoS One 2016; 11: e0154930 DOI: 10.1371/journal.pone.0154930.
• 12 Haulon S, Greenberg RK, Spear R. et al. Global experience with an inner branched arch endograft. J Thorac Cardiovasc Surg 2014; 148: 1709-1716 DOI: 10.1016/j.jtcvs.2014.02.072.
• 13 Fujimura N, Ichihashi S, Motoki M. et al. Anatomical Analysis and Feasibility Study of Next-Generation Fenestrated or Branched Stent-Grafts for the Treatment of Arch Aneurysms. J Endovasc Ther 2020; 27: 777-784 DOI: 10.1177/1526602820938058.
• 14 Milne CP, Amako M, Spear R. et al. Inner-Branched Endografts for the Treatment of Aortic Arch Aneurysms After Open Ascending Aortic Replacement for Type A Dissection. Ann Thorac Surg 2016; 102: 2028-2035 DOI: 10.1016/j.athoracsur.2016.05.012.
• 15 Prendes CF, Banafsche R, Stana J. et al. Technical Aspects of Fenestrated Arch TEVAR With Preloaded Fenestration. J Endovasc Ther 2021; DOI: 10.1177/15266028211007469.
• 16 Yokoi Y, Azuma T, Yamazaki K. Advantage of a precurved fenestrated endograft for aortic arch disease: simplified arch aneurysm treatment in Japan 2010 and 2011. J Thorac Cardiovasc Surg 2013; 145 (3 Suppl.): S103-S109 DOI: 10.1016/j.jtcvs.2012.11.058.
• 17 Tsilimparis N, Law Y, Rohlffs F. et al. Fenestrated endovascular repair for diseases involving the aortic arch. J Vasc Surg 2020; 71: 1464-1471 DOI: 10.1016/j.jvs.2019.06.205.
• 18 Tsilimparis N, Prendes CF, Rouhani G. et al. Fenestrated Preloaded Thoracic Endografts for Distal Aortic Arch Pathologies: Multicentre Retrospective Analysis of Short and Mid-term Outcomes. Eur J Vasc Endovasc Surg [in press].
• 19 Fernández-Alonso L, Fernández Alonso S, Martínez Aguilar E. et al. Fenestrated and Scalloped Endovascular Grafts in Zone 0 and Zone 1 for Aortic Arch Disease. Ann Vasc Surg 2020; 69: 360-365 DOI: 10.1016/j.avsg.2020.06.009.
• 20 Spear R, Haulon S, Ohki T. et al. Editorʼs Choice – Subsequent Results for Arch Aneurysm Repair with Inner Branched Endografts. Eur J Vasc Endovasc Surg 2016; 51: 380-385 DOI: 10.1016/j.ejvs.2015.12.002.
• 21 Tsilimparis N, Detter C, Law Y. et al. Single-center experience with an inner branched arch endograft. J Vasc Surg 2019; 69: 977-985.e1 DOI: 10.1016/j.jvs.2018.07.076.
• 22 Bosse C, Kölbel T, Mougin J. et al. Off-the-shelf multibranched endograft for total endovascular repair of the aortic arch. J Vasc Surg 2020; 72: 805-811 DOI: 10.1016/j.jvs.2019.11.046.
• 23 Law Y, Kölbel T, Detter C. et al. Emergency Use of Branched Thoracic Endovascular Repair in the Treatment of Aortic Arch Pathologies. Ann Thorac Surg 2019; 107: 1799-1806 DOI: 10.1016/j.athoracsur.2018.09.020.
• 24 Stana J, Fernandes Prendes C, Banafsche R. et al. Emergent Triple-Branched TEVAR and Redistribution of the Branches to the Supra-Aortic Target Vessels for Treatment of a Contained Ruptured Descending Aortic Aneurysm Associated With a Chronic Type A Aortic Dissection. J Endovasc Ther 2021; 28: 309-314 DOI: 10.1177/1526602820985270.
• 25 Ferrer C, Cao P, Coscarella C. et al. iTalian RegIstry of doUble inner branch stent graft for arch PatHology (the TRIUmPH Registry). J Vasc Surg 2019; 70: 672-682.e1 DOI: 10.1016/j.jvs.2018.11.046.
• 26 Dake MD, Fischbein MP, Bavaria JE. et al. Evaluation of the Gore TAG thoracic branch endoprosthesis in the treatment of proximal descending thoracic aortic aneurysms. J Vasc Surg 2021; DOI: 10.1016/j.jvs.2021.04.025.
• 27 Makaloski V, Tsilimparis N, Rohlffs F. et al. Endovascular total arch replacement techniques and early results. Ann Cardiothorac Surg 2018; 7: 380-388 DOI: 10.21037/acs.2018.04.02.
• 28 Chiesa R, Melissano G, Tshomba Y. et al. Ten years of endovascular aortic arch repair. J Endovasc Ther 2010; 17: 1-11 DOI: 10.1583/09-2884.1.
• 29 Gelpi G, Vanelli P, Mangini A. et al. Hybrid aortic arch repair procedure: reinforcement of the aorta for a safe and durable landing zone. Eur J Vasc Endovasc Surg 2010; 40: 709-714 DOI: 10.1016/j.ejvs.2010.08.017.
• 30 Antoniou GA, Mireskandari M, Bicknell CD. et al. Hybrid repair of the aortic arch in patients with extensive aortic disease. Eur J Vasc Endovasc Surg 2010; 40: 715-721 DOI: 10.1016/j.ejvs.2010.08.024.
• 31 Konstantinou N, Debus ES, Vermeulen CFW. et al. Cervical Debranching in the Endovascular Era: A Single Centre Experience. Eur J Vasc Endovasc Surg 2019; 58: 34-40 DOI: 10.1016/j.ejvs.2018.12.010.
• 32 Moulakakis KG, Mylonas SN, Markatis F. et al. A systematic review and meta-analysis of hybrid aortic arch replacement. Ann Cardiothorac Surg 2013; 2: 247-260 DOI: 10.3978/j.issn.2225-319X.2013.05.06.
• 33 Pichlmaier M, Tsilimparis N, Hagl C. et al. New anatomical frozen elephant trunk graft for Zone 0: endovascular technology reduces invasiveness of open surgery to the max. Eur J Cardiothorac Surg 2021; DOI: 10.1093/ejcts/ezab394.
• 34 Larzon T, Gruber G, Friberg O. et al. Experiences of intentional carotid stenting in endovascular repair of aortic arch aneurysms–two case reports. Eur J Vasc Endovasc Surg 2005; 30: 147-151 DOI: 10.1016/j.ejvs.2005.02.049.
• 35 Greenberg RK, Clair D, Srivastava S. et al. Should patients with challenging anatomy be offered endovascular aneurysm repair?. J Vasc Surg 2003; 38: 990-996 DOI: 10.1016/s0741-5214(03)00896-6.
• 36 Donas KP, Marchiori E, Inchingolo M. et al. Surgical Treatment of Endotension after Chimney Endovascular Repair of a Symptomatic Juxtarenal Aneurysm. Ann Vasc Surg 2017; 41: 279.e5-279.e8 DOI: 10.1016/j.avsg.2016.09.029.
• 37 Patel HJ, Dake MD, Bavaria JE. et al. Branched Endovascular Therapy of the Distal Aortic Arch: Preliminary Results of the Feasibility Multicenter Trial of the Gore Thoracic Branch Endoprosthesis. Ann Thorac Surg 2016; 102: 1190-1198 DOI: 10.1016/j.athoracsur.2016.03.091.
• 38 Hogendoorn W, Schlösser FJ, Moll FL. et al. Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg 2013; 58: 502-511 DOI: 10.1016/j.jvs.2013.03.043.
• 39 Redlinger RE, Ahanchi SS, Panneton JM. In situ laser fenestration during emergent thoracic endovascular aortic repair is an effective method for left subclavian artery revascularization. J Vasc Surg 2013; 58: 1171-1177 DOI: 10.1016/j.jvs.2013.04.045.
• 40 Murphy EH, Dimaio JM, Dean W. et al. Endovascular repair of acute traumatic thoracic aortic transection with laser-assisted in-situ fenestration of a stent-graft covering the left subclavian artery. J Endovasc Ther 2009; 16: 457-463 DOI: 10.1583/09-2746.1.
• 41 Kopp R, Katada Y, Kondo S. et al. Multicenter Analysis of Endovascular Aortic Arch In Situ Stent-Graft Fenestrations for Aortic Arch Pathologies. Ann Vasc Surg 2019; 59: 36-47 DOI: 10.1016/j.avsg.2019.02.005.