Current management of thoracoabdominal aortic aneurysms: Patient-based selection strategy

Historically, open surgical repair of thoracoabdominal aortic aneurysms (TAAAs) has involved greater operative risk than repairs of aneurysms in other aortic segments. Experienced surgical centers now have much lower mortality and morbidity rates for TAAA repair than they once did, largely because of the development of surgical techniques to prevent end-organ ischemia, and surgical repair is now widely considered the gold standard. However, in a few centers, endovascular stent-grafting is emerging as an alternative treatment for TAAAs. At present, this technology is quite complex, and more endovascular experience is needed to determine its long-term and multicenter feasibility. It is likely that the selective use of endovascular repair, especially when combined with open surgical debranching of the visceral arteries, will become an increasingly valuable approach in patients considered a poor risk for open repair. Much greater use and more years of postprocedural monitoring, as well as simplified technologies, will be necessary before hybrid surgical and endovascular repair can be considered a valid paradigm for TAAA repair.