title: Do branched and fenestrated devices have a role in chronic type B aortic dissection?
abstract: Morbidity and mortality after conventional open repair of post-dissecting thoracoabdominal aortic aneurysms (TAAA) remain high despite the improvement of results. Recently, "hybrid" open de-branching procedures combined with endovascular stent-grafting of the atherosclerotic thoracic aortic aneurisms have been performed, as an alternative approach. However, patients with significant cardiac, pulmonary or renal comorbidities, may represent an unfit cohort also for such hybrid procedures, and, of consequence, may be resigned to medical treatment. Recent experiences with fenestrated and branched stent-grafts have opened new opportunities in the treatment of extensive aortic aneurysms involving the visceral and renal arteries, particularly in case of atherosclerotic aneurysms. Post-dissection thoracoabdominal aneurysms present with additional challenges such as narrow true lumen at the level of the visceral vessels origin, and the lack of a stable distal landing zone. In this report, we discuss the role of fenestrated and branched stent-grafts as feasible treatment of post-dissecting TAAA.
authors.affiliation: Research Center for Thoracic Aortic Diseases, Policlinico San Donato IRCCS, University of Milan, Milan, Italy. santi.trimarchi@unimi.it
authors.forename: S
authors.initials: S
authors.lastname: Trimarchi
authors.forename: P
authors.initials: P
authors.lastname: Righini
authors.forename: V
authors.initials: V
authors.lastname: Grassi
authors.forename: C
authors.initials: C
authors.lastname: Lomazzi
authors.forename: S
authors.initials: S
authors.lastname: Segreti
authors.forename: V
authors.initials: V
authors.lastname: Rampoldi
authors.forename: E
authors.initials: E
authors.lastname: Verhoeven
mesh_terms: D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D018579:Patient Selection; D011474:Prosthesis Design; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome