Endovascular repair of thoracic aortic aneurysms: Toward a new standard of treatment

Despite recent improvements in surgical techniques and patient care, open surgery for degenerative aneurysms in the thoracic aorta is still associated with major morbidity in the form of death, cardiac, renal and neurological complications. Recent clinical experience indicates that most of thoracic aortic pathology is potentially amenable to minimally invasive therapy with endovascular stent graft repair. Single-center series as well as the first comparative studies in the form of case-control comparisons demonstrate that endovascular treatment offers an early postoperative outcome more favorable than open surgery. Hybrid procedures, which combine an open surgical step for branch vessel rerouting to create a stent-graft seal zone where none existed, have been applied increasingly to afford a stent-graft option in patients with lesions involving the aortic arch or visceral aorta. Endograft technology is still in evolution. Future refinements will address some of the most important needs like lower profile delivery systems, greater device flexibility, precise deliverability and deployment characteristics that will contribute to achieve optimal success and safety, especially in the region of the aortic arch. Endovascular treatment of complex thoraco-abdominal aneurysms and arch aneurysms with fenestrated or branched endografts has recently been introduced in the clinical setting in small series in few centers with a focused expertise. Preliminary results are promising but the more widespread use of this technology should not occur until longer-term results will become available.