Endovascular Treatment of Thoracic Aorta

Abstract

The emergence of endovascular stent grafting as an alternative therapy to open surgical repair of thoracic aortic pathologies is an exciting advancement. Although it is apparent that high-risk patients will benefit from this technology, the exact role of stent grafting remains to be defined as we accumulate long-term data and as devices and technology evolve. Rather than replacing conventional surgical treatment, endovascular repair will likely play a complementary role and offer a less-invasive option in the treatment armamentarium. Clearly, there are limitations of both approaches; however, while high risk for surgery is defined by clinical parameters, comorbidities, and physiological reserve, contraindications for endovascular stent-graft treatment are defined mostly by anatomical criteria such as too wide aorta to provide landing zones for an endoprosthesis or already irreversible paraplegia. Nevertheless, treatment should be carried out only in a center with experience in both endovascular and surgical procedures and with adequate technical facilities. Treatment of thoracic aortic pathologies should be subject to prior multidisciplinary discussion, particularly with regard to risks of conversion and need for cardiopulmonary bypass. All patients should have access to a structural follow-up plan offering both regular clinical assessment and professional imaging follow-up by CT or MR angiography.