Aortenaneurysma: fenestrierte/gebranchte abdominale EVAR (fbEVAR) und fenestrierte/gebranchte thorakale EVAR (fbTEVAR). Ist die komplette endovaskuläre Therapie schon da?

Zusammenfassung

Fünf Jahre nach der ersten endovaskulären Aortenrekonstruktion (EVAR) berichten Park et al. über die erste Implantation einer fenestrierten Endoprothese. In der Zwischenzeit wurden mehrere fortgeschrittene Generationen von fenestrierten und gebranchten Prothesen entwickelt. Diese können in den meisten Fällen in 2 Gruppen unterteilt werden. Zur 1. Gruppe gehören die „custom-made“-Prothesen, die für elektive Operationen individuell für Patienten mit spezifischer Anatomie hergestellt werden. Eine 2. Gruppe bilden die sog. „off-the-shelf“-Prothesen, die sich durch vom Hersteller vergebene Charakteristika im Sinne von Länge, Breite und Durchmesser auszeichnen und bei allen Prothesen gleich sind. Die offene gefäßchirurgische Therapie der thorakoabdominellen Aortenaneurysmen ist selbst bei elektiven Eingriffen mit relevanter Mortalität und Morbidität assoziiert. Die Entwicklung von endovaskulären Modalitäten wie z. B. fenestrierte oder gebranchte endovaskuläre Aortenrekonstruktionen (F-EVAR, B-EVAR) ermöglichten die Nutzung weniger invasiver Prozeduren für die Behandlung der komplexen Aortenpathologien sowohl im thorakoabdominalen Abschnitt als auch im Aortenbogen. Eine umfassende Behandlung aller Segmente der Aorta mit endovaskulären Techniken wurde noch nicht vollständig evaluiert. Das Ziel dieses Artikels ist die Präsentation eines Überblicks der zurzeit verfügbaren endovaskulären Möglichkeiten der Behandlung von komplexen abdominellen und thorakoabdominellen Aortenaneurysmen, die sowohl eine komplexe thorakale als auch komplexe abdominale Versorgung benötigen.

Abstract

Five years after the first endovascular aortic repair (EVAR), Park et al. reported the first implantation of a fenestrated endoprosthesis. In the meantime, advanced generations of new fenestrated and branched endografts evolved. Endografts for complex pathologies are either so-called “off-the-shelf” grafts with predetermined length, width, diameter and clock position of the branches and fenestrations, predetermined by the manufacturer, “custom-made” grafts which need to be sized and planned individually for patients with specific thoracoabdominal anatomy. Open aortic repair in the treatment of thoracoabdominal aortic aneurysm (TAAA) still remains challenging and is associated with high morbidity and mortality, even in the elective setting. The ongoing development of endovascular treatment modalities, such as fenestrated and branched endovascular aneurysm repair (F-EVAR, B-EVAR), enables less invasive procedures for more challenging aortic pathologies. In recent years, extensive endovascular treatment of the aortic arch to the thoracoabdominal segment has become more and more important, but its outcomes have not been completely evaluated. The aim of this is article is to provide an overview of the currently available endovascular treatment options for complex aortic aneurysms requiring extensive coverage from the aortic arch to the infrarenal aorta.

Schlüsselwörter

endovaskuläre Therapie - Aortenaneurysma - Aortenstentprothese - Aortendissektion - Aortenchirurgie - Gefäßchirurgie

Key words

aortic aneurysm - aortic stent prosthesis - aortic surgery - aortic dissection - vascular surgery - endovascular surgery

Publication History

Article published online:
13 July 2020

• Literatur

• 1 Volodos NL, Karpovich IP, Shekhanin VE. et al. [A case of distant transfemoral endoprosthesis of the thoracic artery using a self-fixing synthetic prosthesis in traumatic aneurysm]. Grudn Khir 1988; (06) 84-86
• 2 Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 1991; 5: 491-499 doi:10.1007/BF02015271
• 3 Park JH, Chung JW, Choo IW. et al. Fenestrated stent-grafts for preserving visceral arterial branches in the treatment of abdominal aortic aneurysms: preliminary experience. J Vasc Interv Radiol 1996; 7: 819-823 doi:10.1016/s1051-0443(96)70854-0
• 4 Dayama A, Sugano D, Reeves JG. et al. Early outcomes and perioperative risk assessment in elective open thoracoabdominal aortic aneurysm repair: an analysis of national data over a five-year period. Vascular 2016; 24: 3-8 doi:10.1177/1708538114568416
• 5 Spanos K, Kölbel T, Kubitz JC. et al. Risk of spinal cord ischemia after fenestrated or branched endovascular repair of complex aortic aneurysms. J Vasc Surg 2019; 69: 357-366 doi:10.1016/j.jvs.2018.05.216
• 6 Maurel B, Delclaux N, Sobocinski J. et al. The impact of early pelvic and lower limb reperfusion and attentive peri-operative management on the incidence of spinal cord ischemia during thoracoabdominal aortic aneurysm endovascular repair. Eur J Vasc Endovasc Surg 2015; 49: 248-254 doi:10.1016/j.ejvs.2014.11.017
• 7 Dias NV, Sonesson B, Kristmundsson T. et al. Short-term outcome of spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2015; 49: 403-409 doi:10.1016/j.ejvs.2014.12.034
• 8 Ko D, Park HS, Kim JY. et al. Early experiences of endovascular aneurysm repair for ruptured abdominal aortic aneurysms. Ann Surg Treat Res 2019; 96: 138-145 doi:10.4174/astr.2019.96.3.138
• 9 Conrad MF, Ergul EA, Patel VI. et al. Evolution of operative strategies in open thoracoabdominal aneurysm repair. J Vasc Surg 2011; 53: 1195-1201.e1 doi:10.1016/j.jvs.2010.11.055
• 10 Coselli JS, LeMaire SA, Köksoy C. et al. Cerebrospinal fluid drainage reduces paraplegia after thoracoabdominal aortic aneurysm repair: results of a randomized clinical trial. J Vasc Surg 2002; 35: 631-639 doi:10.1067/mva.2002.122024
• 11 Sweeting MJ, Patel R, Powell JT. et al. Endovascular repair of abdominal aortic aneurysm in patients physically ineligible for open repair: very long-term follow-up in the EVAR-2 randomized controlled trial. Ann Surg 2017; 266: 713-719 doi:10.1097/SLA.0000000000002392
• 12 Katsargyris A, Oikonomou K, Klonaris C. et al. Comparison of outcomes with open, fenestrated, and chimney graft repair of juxtarenal aneurysms: are we ready for a paradigm shift?. J Endovasc Ther 2013; 20: 159-169 doi:10.1583/1545-1550-20.2.159
• 13 Mastracci TM, Greenberg RK, Eagleton MJ. et al. Durability of branches in branched and fenestrated endografts. J Vasc Surg 2013; 57: 926-933 doi:10.1016/j.jvs.2012.09.071
• 14 Stackelberg O, Lindström D, Mani K. et al. Outcomes after endovascular repair of abdominal aortic aneurysm involving the renovisceral arteries: a multi-center follow-up study. Vascular 2019; 27: 397-404 doi:10.1177/1708538119836016
• 15 Roy IN, Millen AM, Jones SM. et al. Long-term follow-up of fenestrated endovascular repair for juxtarenal aortic aneurysm. Br J Surg 2017; 104: 1020-1027 doi:10.1002/bjs.10524
• 16 Heidemann F, Tsilimparis N, Rohlffs F. et al. Staged procedures for prevention of spinal cord ischemia in endovascular aortic surgery. Gefasschirurgie 2018; 23 (Suppl. 02) S39-S45 doi:10.1007/s00772-018-0410-z
• 17 Spanos K, Kölbel T, Theodorakopoulou M. et al. Early outcomes of the t-Branch off-the-shelf multibranched stent-graft in urgent thoracoabdominal aortic aneurysm repair. J Endovasc Ther 2018; 25: 31-39 doi:10.1177/1526602817747282
• 18 Tsilimparis N, Konstantinou N, Heidemann F. et al. Surgeon-modified endografts and off-the-shelf multi branched devices in complex aortic emergencies. Aortic complexities Edi. Ermes 2018; 13: 113-119
• 19 Scheerbaum M, Kölbel T, Rohlffs F. et al. Back-table surgeon modification of a t-Branch. Ann Vasc Surg 2017; 45: 330-335 doi:10.1016/j.avsg.2017.07.011
• 20 Riambau V, Böckler D, Brunkwall J. et al. Editorʼs choice – management of descending thoracic aorta diseases: clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2017; 53: 4-52 doi:10.1016/j.ejvs.2016.06.005
• 21 Cheng D, Martin J, Shennib H. et al. Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease a systematic review and meta-analysis of comparative studies. J Am Coll Cardiol 2010; 55: 986-1001 doi:10.1016/j.jacc.2009.11.047
• 22 Spear R, Hertault A, van Calster K. et al. Complex endovascular repair of postdissection arch and thoracoabdominal aneurysms. J Vasc Surg 2018; 67: 685-693 doi:10.1016/j.jvs.2017.09.010
• 23 Tsilimparis N, Debus ES, von Kodolitsch Y. et al. Branched versus fenestrated endografts for endovascular repair of aortic arch lesions. J Vasc Surg 2016; 64: 592-599 doi:10.1016/j.jvs.2016.03.410
• 24 Tsilimparis N, Detter C, Heidemann F. et al. Branched endografts in the aortic arch following open repair for DeBakey Type I aortic dissection. Eur J Cardiothorac Surg 2018; 54: 517-523 doi:10.1093/ejcts/ezy133
• 25 Verscheure D, Haulon S, Tsilimparis N. et al. Endovascular treatment of post type A chronic aortic arch dissection with a branched endograft: early results from a retrospective international multicenter study. Ann Surg 2019; DOI: 10.1097/SLA.0000000000003310.
• 26 Gandet T, Ozdemir BA, Trubert LC. et al. Physician-modified thoracic stent grafts for the arch after surgical treatment of type A dissection. Ann Thorac Surg 2019; 108: 491-498 doi:10.1016/j.athoracsur.2019.02.026
• 27 Fiorucci B, Banafsche R, Jerkku T. et al. Das thorakale Aortenaneurysma – Diagnostik und Behandlungsstrategien. Dtsch Med Wochenschr 2019; 144: 146-151 doi:10.1055/a-0648-0207
• 28 Spear R, Sobocinski J, Settembre N. et al. Early experience of endovascular repair of post-dissection aneurysms involving the thoraco-abdominal aorta and the arch. Eur J Vasc Endovasc Surg 2016; 51: 488-497 doi:10.1016/j.ejvs.2015.10.012
• 29 Tsilimparis N, Haulon S, Spanos K. et al. Combined fenestrated-branched endovascular repair of the aortic arch and the thoracoabdominal aorta. J Vasc Surg 2020; 71: 1825-1833 doi:10.1016/j.jvs.2019.08.261
• 30 Spear R, Clough RE, Fabre D. et al. Total endovascular treatment of aortic arch disease using an arch endograft with 3 inner branches. J Endovasc Ther 2017; 24: 534-538 doi:10.1177/1526602817714569
• 31 Makaloski V, Tsilimparis N, Rohlffs F. et al. Use of a steerable sheath for retrograde access to antegrade branches in branched stent-graft repair of complex aortic aneurysms. J Endovasc Ther 2018; 25: 566-570 doi:10.1177/1526602818794965