Endovascular Treatment of Aortic Pathologies
Özet
This chapter comprehensively discusses endovascular treatment for various aortic pathologies as a modern, minimally invasive alternative to traditional open surgery. These advanced endovascular interventions, primarily including Endovascular Aortic Repair (EVAR) and Thoracic Endovascular Aortic Repair (TEVAR), have transitionally become routine clinical practices, especially for high-risk patients who exhibit severe comorbidities. Successful patient selection requires a meticulous multidisciplinary evaluation of anatomical suitability, age, and cardiac or respiratory functions. For complex cases like juxtarenal aneurysms, specialized procedures such as the endovascular chimney technique and customized fenestrated endografts are deployed to safely preserve crucial blood flow to visceral and renal branches. Proper implementation relies on key mechanical principles, including secure graft fixation, adequate sealing zones, and precise oversizing of the stent-graft by 10-20%. However, the procedure carries notable postoperative risks such as spinal cord ischemia, stroke, device migration, and postimplantation syndrome. Additionally, "endoleak," classified into five distinct types representing blood leakage into the aneurysm sac, remains a critical challenge that can cause treatment failure. Overall, endovascular approaches significantly reduce perioperative mortality and morbidity, offering a dependable therapeutic standard for complex aortic diseases.
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