Page 242 - Read Online

Page 4 of 5 Chang et al. Vessel Plus 2020;4:20 I http://dx.doi.org/10.20517/2574-1209.2020.10

FINAL REMARKS
Reports from the International Registry of Acute Aortic Dissections show that 10% to 30% of ATAAD
patients are considered too high risk to receive open repair and would therefore receive only medical
management with up to 60% early mortality rates [3,18] . From an anatomical aspect, based on valvular
condition, landing zone, and coronary involvement, 30% to 50% of patients are technically suitable for
[19]
TEVAR . To date, ascending TEVAR strategies appear encouraging in the treatment of various ascending
aortic pathologies. Thus, ascending TEVAR is feasible and reveals promising early and short-term results
based on our updated literature review [Supplementary Table 1]. Nevertheless, the complexity of the
anatomy in the ascending aorta continues to be a major obstacle for the use of current endovascular
technologies. In other words, ascending TEVAR is often highly compromised by anatomic limitations with
the short length of the ascending aorta, the location of the coronary ostia, the location of the entry tear,
[13]
and the supra-aortic branches . Of them, the most common criteria contradictory for ascending TEVAR
was the lack of a sufficient landing zone (i.e., the distance between the coronary ostia and the entry tear
[8]
has been measured to be less than 20 mm [13,20] ). Notably, Roselli et al. pointed out that the greater curve
[8]
is more than 30% longer than the lesser curve along the length of the ascending aorta . Thus, the next-
generation ascending stent-graft device needs to be highly conformable and elastic with adequate strength
[8]
of fixation in what is a hostile environment . In summary, there are no commercially available designs
of endovascular devices specifically for the ascending aorta currently. The current iteration of stent-graft
[3]
technology however, needs to be adapted to the specific anatomic features of the ascending aorta . It is
envisioned that with time, combining new knowledge and technological advancements will further pave
the way for broader application of ascending TEVAR for patients with TAAD.

DECLARATIONS
Authors’ contributions
Authors made substantial contributions to the conception and design of the study, and participated in
drafting the article: Chang TW, Yang TT
Authors provided administrative, technical, and material support: Jhou HJ, Ke LY
The author participated in critical revision for important conceptual and intellectual content and gave final
approval of the version to be submitted to the Journal: Chen YF

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.