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CC BY 4.0 · Aorta (Stamford) 2022; 10(03): 095-103
DOI: 10.1055/s-0042-1748842
State-of-the-Art Review

Early Repair of Aortic Wall Structural Defect by “Net” Endoprosthesis to Arrest the Aneurysm without Interference with Aortic Branch Vessel Perfusion

Stefano Nazari 
1   Department of Research, Fondazione Alexis Carrel, Basiglio (MI), Italy
› Author Affiliations Funding Partially funded by IRCCS SAN MATTEO HOS PAVIA 1992-1995.
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Abstract

Current treatments of aortic aneurysm include surgical or endovascular, respectively, anatomical or functional, substitution of the aneurysm tract; however, with these methods, perfusion of at least some collateral branches cannot be fully restored, leading to the risk of paraplegia. We present a novel endovascular “net” prosthesis to strengthen the aortic wall while preserving perfusion of collateral branches. This consists of a polyester mesh “net”-layered conduit in a variable cylindrical shape, which is personalized based on patient computed tomography scan images, and is defined by circular crossing spirals of a thin nitinol wire. The prosthetic conduit, shrunk by compressing the nitinol spirals, can be inserted into the vascular lumen and expanded in situ. Then, the insertion control device can be fully removed. Thus, the, “net” prosthesis, positioned inside the aorta in stable contact with the intimal wall for 2 to 5 months, is colonized by neointima and spontaneously moved deeper into the aortic wall in contact with the media, thus being ideally able to stabilize aortic diameter without interference with collateral branch blood perfusion. This new, (ideally) paraplegia-free procedure is aimed at curing the aortic wall structural defect, thus arresting the aneurysm from further progression. This contrasts with current treatments, indicated by aneurysm dimensions for their implied complication risk, which are actually for prophylaxis of impending rupture or dissection rather than fortification of the natural aorta. Moreover, this new approach can be used alongside open surgical procedures (personalized external aortic root support) as well as a frozen “net” elephant trunk technique, for full aortic stabilization.

Keywords

aneurysm - dissection - paraplegia - PEARS - TEVAR - prophylaxis - cure


Publication History

Received: 25 February 2021

Accepted: 04 October 2021

Article published online:
01 November 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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