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Evaluation des innovations endovasculaires pour le traitement des dissections aortiques de type B

Abstract : Thoracic endovascular aortic repair (TEVAR) is considered as the first line therapy for complicated acute type B aortic dissection (cABAD). However, current endovascular treatment has limitation regarding the proximal anchoring when aortic arch is involved and regarding the dissected aorta distally to the stent graft leading to early and late complication.The aim of this work was to assess new endovascular techniques to optimise endovascular treatment of ABAD in the aortic arch and in the thoraco-abdominal aorta.We reported the first model of ABAD in human cadaveric aorta, which was reproducible, extended to the infra-renal aorta and close to clinical pattern, allowing for human aortic devices assessment.We assess on this model extensive bare metal stenting of the dissected aorta, which was effective in true lumen reexpansion but induced a drop in pressure in the visceral arteries in 54% when they were supplied by the false lumen.Then, we assessed the results of this technique, associated with balloon inflation of the bare stent in clinical practice, which allowed an immediate and mid-term persisting complete remodelling of the stented thoraco-abdominal aorta, with a low dissecting aneurysmal evolution at one year of follow-up.Finally we reported a model of physician modified scalloped stent graft on currently available thoracic aortic device to extend the proximal landing zone in the arch while preserving the supra aortic trunks.These finding allow for potential improvement of endovascular treatment of ABAD but also of acute type A dissection, chronic dissection and some other acute aortic arch diseases.
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https://tel.archives-ouvertes.fr/tel-01947034
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Submitted on : Thursday, December 6, 2018 - 3:11:06 PM
Last modification on : Wednesday, September 23, 2020 - 2:19:52 PM
Long-term archiving on: : Thursday, March 7, 2019 - 2:04:07 PM

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Elsa Madeleine Faure. Evaluation des innovations endovasculaires pour le traitement des dissections aortiques de type B. Médecine humaine et pathologie. Université Montpellier, 2018. Français. ⟨NNT : 2018MONTT030⟩. ⟨tel-01947034⟩

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