期刊
THORACIC AND CARDIOVASCULAR SURGEON
卷 69, 期 4, 页码 357-361出版社
GEORG THIEME VERLAG KG
DOI: 10.1055/s-0040-1710581
关键词
review; TEVAR; stent-graft; rapid pacing; induced hypotension; inflow occlusion; adenosine
TEVAR surgery requires a sufficient landing zone for safe anchoring of the stent-graft and prevention of endoleaks, while certain areas may be limited by major aortic side-branches. Accurate deployment of the stent-graft and measures to prevent side-branch occlusion are crucial for successful outcomes.
Thoracic endovascular aortic repair (TEVAR) for aortic pathologies requires sufficient landing zone of ideally more than 25mm 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.
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