Abstract:

Among the 123 patients treated in our department by endovascular stent graft, 113 (91.8%) were identified as having involvement of the isthmus. Therefore, the incorrectly defined descending aortic disease is essentially a pathology of the isthmus that represents the distal portion of the arch. The key to the treatment of all types of aortic lesions rests on understanding the morphology of this region gifted with a "double S" configuration. Current thoracic devices are noncompliant systems and should be modified greatly, taking into account that the media of the aorta has a semi-compliant behavior. The resultant of power transmission is oriented at 45° and produces a transmural radial force that animal implantation has demonstrated to be a torsional movement. The improvements in new devices actually result in a new generation of endoprostheses that seem to be closely related to the anatomy of the patient by increasing the conformability and, therefore, we expect an increase in durability. To test these features, we have studied a new stent graft in different settings of thoracic aortic disease. The new device should conform to current standards while simultaneously transmitting torsional forces. The dedicated delivery system should be arch-compatible, flexible but sufficiently rigid, and able to be three-dimensionally oriented. Moreover, the new stent graft should follow the three-dimensional anatomy of the "double S" configuration of the isthmus area and thus reduce the mismatch between the aorta and the device itself.

Authors:

Alessandro S. Bortone, M.D., Ph.D., F.E.S.C., Institute of Cardiac Surgery; Emanuela de Cillis, M.D., Institute of Cardiac Surgery; Donato D'Agostino, M.D., Institute of Cardiac Surgery; Michele Sciascia, M.S., Institute of Cardiac Surgery; Luigi de Luca Tupputi Schinosa, M.D., Institute of Cardiac Surgery, University of Bari School of Medicine, Bari, Italy

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