The use of stent grafts for endovascular treatment of aneurysmal or dissected aortic segments has not yet been sufficiently investigated in these patients. Only case reports and case series with small numbers of patients have been published, which in summary describe the technical feasibility of the procedure with a low rate of periprocedural mortality, but without any long-term results (Baril et al. 2006; Botta et al. 2009; Geisbusch et al. 2008; Nordon et al. 2009). The published results are also inconsistent with regard to the success of the treatment (Botta et al. 2009). A common feature in the published case series is the high proportion of patients who have undergone previous surgery with replacement of the ascending aorta or aortic arch, presence of distal dissection with dilation of the false lumen and a high rate of secondary interventions (Fig. 2.1-26). With the increasing life expectancy and frequent previous operations in patients with Marfan syndrome, for example, the endovascular treatment options in principle represent an attractive and less invasive alternative.
2.1.9.6 Prospects
The increasingly wide range of different drug-based, surgical and interventional treatment options available is likely to lead to growing differentiation in the criteria for using them. Highly individualized decision-making criteria will apply. Molecular genetics will play a progressively important role here (von Kodolitsch et al. 2010). In addition, with the normalization of life expectancy for the affected patients, the issue of quality of life for young patients will also become paramount. The affected patients want to be able to live with as much freedom from prohibited behaviors as possible and to take part in all aspects of occupational and social life, sports and leisure activities. This area will require further research on care provision and the development of programs for rehabilitating patients with Marfan syndrome and other hereditary aortic diseases.
Fig. 2.1–26 Computed tomography of the aorta in a patient with classic Marfan syndrome, showing the prosthesis in the ascending aorta after treatment with a bio-conduit for an aortic root aneurysm with high-grade aortic valve insufficiency when the patient was aged 71. Due to a progressive false-lumen aneurysm with a chronic Stanford type B aortic dissection, with an overall diameter of the aorta of 71 mm, repeat treatment was carried out when the patient was aged 74, with placement of an aortic stent graft following initial stent graft implantation in the aortic arch and descending aorta when the patient was 69. The current CT shows good results with the stent treatment, with successful exclusion of the aneurysm. However, renewed aneurysm formation can be seen at the distal end of the stent graft.
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