Muetterties CE et al. – This systematic review discussed the types of endovascular aortic stents and associated vascular access used in repair of ascending aorta to understand the real-world endovascular approaches. Endovascular technologies are successfully used to treat patients with a range of ascending aortic diseases, despite the absence of a dedicated aortic stent graft. For optimal outcomes, aortic anatomy should be aligned with the limited device sizing options and should be reserved for patients at high surgical risk.

Results

• In 118 patients from 46 selected publications, 13 different aortic stent grafts were used. Common device types included thoracic stents (71.2%) along with abdominal cuffs (11%) and custom-made grafts (10.2%).
• Type A aortic dissection (50%) was the most commonly treated aortic disease, followed by aortic pseudoaneurysm (29.7%), aortic aneurysm (5.1%), penetrating atherosclerotic ulcer (4.2%), and acute aortic rupture (2.5%).
• Femoral arterial access was used in 62.7% of patients. Other approaches included transapical (14.4%), carotid (12.7%), and axillary (6.8%) access.
• An overall rate of 18.6% was reported for type I endoleak. All-cause mortality (15.2%), conversions to open surgery (3.4%), and cerebrovascular complications (3.4%) were also reported.
• Aorta-related mortality was 5%.
• Average follow-up was 17.2 months.