New treatment approaches create new disease processes: A short guide on how to reduce unexpected events to a minimum

摘要

When thoracic endovascular aortic repair was introduced 2 decades ago, enthusiasm was great and open surgery was already deemed futile. As with each and every new technology, the hype flattened as obvious (endoleaks, continuing dilation of landing zones) and nonobvious limitations of the technique became known.1 One of the initially nonobvious limitations was that retrograde type A aortic dissection, the knowledge of which had to develop over time, was due to interaction of the still rigid stent-graft and the highly elastic aortic wall, where the effect was even more pronounced the more proximal the deployment was done.2 We had to learn that particularly in patients with the underlying diagnosis of type B aortic dissection, despite regular diameters, the tissue texture of the proximal thoracic aorta (root, ascending and arch) is not comparable to that of patients with descending aortic aneurysms or penetrating atherosclerotic ulcerations.3