Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.011417
Jornal Vascular Brasileiro
Review Article

Contemporary strategies for repair of complex thoracoabdominal aortic aneurysms: real-world experiences and multilayer stents as an alternative

Estratégias contemporâneas para reparo de aneurismas da aorta toracoabdominal: experiências reais e stents multilayer como alternativa

Ralf Robert Kolvenbach

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Abstract

Thoracoabdominal aortic aneurysms (TAAA) present special challenges for repair due to their extent, their distinctive pathology, and the fact that they typically cross the ostia of one or more visceral branch vessels. Historically, the established treatment for TAAA was open surgical repair, with the first procedure reported in 1955. Endovascular repair of TAAA with fenestrated and/ or branched endografts, has been studied since the beginning of the current century as a means of mechanical aneurysm exclusion. More recently, flow modulator stents have been employed with the aim at reducing shear stress on aortic aneurysmal wall. In this review we present technical and main results of these techniques, based on literature review and personal experience.

Keywords

aortic aneurysm; vascular surgical; endovascular procedures; stents; endoleak

Resumo

Aneurismas da aorta toracoabdominal apresentam desafios especiais no seu reparo devido à sua extensão, patologia distinta, e pelo fato de que tipicamente eles atravessam o óstio de um ou mais vasos de ramos viscerais. Historicamente, o tratamento estabelecido para aneurismas da aorta toracoabdominal foi o reparo em cirurgia aberta, com o primeiro procedimento relatado em 1955. O reparo endovascular de aneurismas da aorta toracoabdominal com endoenxertos fenestrados e/ou ramificados tem sido estudado desde o início deste século como meio de exclusão mecânica do aneurisma. Mais recentemente, stents moduladores de fluxo têm sido empregados com o objetivo de reduzir o estresse de cisalhamento na parede do aneurisma de aorta. Nesta revisão, apresentamos os principais resultados obtidos com essas técnicas, com base em revisão de literatura e experiência pessoal.

Palavras-chave

aneurisma de aorta; cirurgia vascular; procedimentos endovasculares; stents; endoleak.

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