Endovascular repair of type A dissection - A long and winding road

In the past three decades, endovascular approaches have revolutionized the treatment of a wide array of ever more complex aortic pathologies from the aortic arch proximally to the iliac bifurcations distally. In parallel, transcatheter aortic valve replacement and coronary artery stenting have become the bread and butter of routine coronary interventions. However, treating the seemingly small segment of a diseased ascending aorta when this extends and involves the aortic valve and coronary arteries remains a great challenge. Rong and co-workers 1 Rong D. Chen X. Han J. et al. Anatomic feasibility of a modular Endo-Bentall stent-graft system for type A aortic dissection. J Vasc Surg. 2023; 78: 1359-1366 Abstract Full Text Full Text PDF Scopus (1) Google Scholar describe an endovascular Bentall approach to overcome these obstacles by combining a modular, branched ascending endovascular device combined with a transapical valve implantation to anchor the reconstruction proximally. Anatomic feasibility of a modular Endo-Bentall stent graft system for type A aortic dissectionJournal of Vascular SurgeryVol. 78Issue 6PreviewThe implementation of thoracic endovascular aortic repair in patients with type A aortic dissection has been strictly constrained due to the pulsatile movement and distensibility and the insufficient length of landing zones on ascending aorta. The most prevalent anatomical limitation is the insufficient length of proximal and distal landing zones. We propose a modularly designed Endo-Bentall stent graft system to broaden the scope of thoracic endovascular aortic repair in the ascending aorta by covering intimal tears in the aortic root and ascending aorta and reconstructing coronary arteries. Full-Text PDF