[Transcardiac Access Routes for Endovascular Treatment of Ascending Aortic Pathologies].
Gold standard for treatment of pathologies of the ascending aorta is still open surgery with extracorporal circulation in moderate to deep hypothermia. These procedures are associated with high morbidity and mortality, especially if performed in older patients or after previous cardiac surgery. Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment option for thoracic aortic pathologies of the descending aorta even in high-risk patients with severe comorbidities resulting in reduced morbidity and mortality compared to open repair. Despite the continuous development of endograft technology an adequate arterial access still poses a relevant limitation of this treatment option accentuated in the proximal segments of the aorta. The transfemoral access may be limited due to severe kinking or arteriosclerotic plaque stenosis of femoral or iliac vessels. Furthermore, the long distance between femoral access vessels and the aortic lesion impairs device torsibility and exact deployment of the stent graft. To provide a practical alternative endovascular access to the ascending aorta, antegrade transcardiac access routes including transapical or transseptal techniques have recently gained increasing interest.
Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg-Eppendorf, Deutschland.
S
S
Wipper
Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg-Eppendorf, Deutschland.
S
S
Debus
Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg-Eppendorf, Deutschland.
C
C
Lohrenz
Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg-Eppendorf, Deutschland.
N
N
Tsilimparis
Klinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg-Eppendorf, Deutschland.
C
C
Detter
Klink für allgemeine und interventionelle Kardiologie, Universitäres Herzzentrum Hamburg-Eppendorf, Deutschland.
Y
Y
von Kodolitsch
Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum Hamburg-Eppendorf, Deutschland.
T
T
Kölbel
D001011:Aorta; D001018:Aortic Diseases / Q000175:diagnosis / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005263:Femoral Artery; D006346:Heart Septum; D006352:Heart Ventricles; D006801:Humans; D011379:Prognosis; D015607:Stents