Thorac Cardiovasc Surg
DOI: 10.1055/s-0040-1710581
Review Article
Georg Thieme Verlag KG Stuttgart · New York

What Is the Best Method to Achieve Safe and Precise Stent-Graft Deployment in Patients Undergoing TEVAR?

1  Department of Cardiac, Thoracic and Vascular Surgery, MediClin Heart Institute Lahr/Baden, Germany
2  Department of Cardiovascular and Endovascular Surgery, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
,
Tim Berger
3  Department of Cardiovascular Surgery, University Heart Center Freiburg, University Freiburg, Bad Krozingen, Germany
4  Department of Cardiovascular Surgery, Medical Faculty of the Albert Ludwigs-University Freiburg, Freiburg, Baden Württemberg, Germany
,
Andreas Voetsch
2  Department of Cardiovascular and Endovascular Surgery, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
,
Andreas Winkler
2  Department of Cardiovascular and Endovascular Surgery, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
,
Philipp Krombholz-Reindl
2  Department of Cardiovascular and Endovascular Surgery, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
,
Andre Farkouh
5  Division of Clinical Pharmacy and Diagnostics, Department of Pharmaceutical Chemistry, Faculty of Life Sciences, University of Vienna, Vienna, Austria
,
Stoyan Kondov
3  Department of Cardiovascular Surgery, University Heart Center Freiburg, University Freiburg, Bad Krozingen, Germany
4  Department of Cardiovascular Surgery, Medical Faculty of the Albert Ludwigs-University Freiburg, Freiburg, Baden Württemberg, Germany
,
Bartosz Rylski
3  Department of Cardiovascular Surgery, University Heart Center Freiburg, University Freiburg, Bad Krozingen, Germany
4  Department of Cardiovascular Surgery, Medical Faculty of the Albert Ludwigs-University Freiburg, Freiburg, Baden Württemberg, Germany
,
Ralf Sodian
1  Department of Cardiac, Thoracic and Vascular Surgery, MediClin Heart Institute Lahr/Baden, Germany
,
Martin Czerny
3  Department of Cardiovascular Surgery, University Heart Center Freiburg, University Freiburg, Bad Krozingen, Germany
4  Department of Cardiovascular Surgery, Medical Faculty of the Albert Ludwigs-University Freiburg, Freiburg, Baden Württemberg, Germany
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Publikationsverlauf

24. Januar 2020

03. April 2020

Publikationsdatum:
19. Juni 2020 (online)

Abstract

Thoracic endovascular aortic repair (TEVAR) for aortic pathologies requires sufficient landing zone of ideally more than 25 mm for safe anchoring of the stent-graft and prevention of endoleaks. In the aortic arch and at the thoracoabdominal transition, landing zone length is usually limited by the offspring of the major aortic side-branches. Exact deployment of the stent-graft to effectively use the whole length of the landing zone and to prevent occlusion of one of the side-branches is key to successful TEVAR. There are numerous techniques described to lower blood pressure and to reduce or eliminate aortic impulse to facilitate exact deployment of stent-grafts including pharmacologic blood pressure lowering, adenosine-induced asystole, inflow occlusion, and rapid pacing. Aim of this review was to assess the current literature to identify which of the techniques is best suited to prevent displacement and allow for precise placement of the stent-graft and safe balloon-molding.