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Thoracic Endovascular Aortic Repair
The treatment of thoracic aortic aneurysms depends on the location of the involved segment. Aneurysms of the ascending aorta and the arch are usually still treated by open repair, although endovascular solutions for these pathologies have been introduced in recent years. Ranging from hybrid procedures to parallel grafts and branched devices, treatment of the more proximal aortic segments will continue to evolve.
On the other hand, thoracic endovascular aortic repair (TEVAR) of aneurysms of the descending thoracic aorta (DTA) has become commonplace over the last several years. Compared with open repair, perioperative and short-term morbidity and mortality are lower with TEVAR. Numerous reports on TEVAR results indicate that elderly patients and those with a high-risk profile especially benefit from this treatment, analogous to endovascular abdominal aneurysm repair (EVAR).
Indications
Corresponding with the treatment rationale for EVAR, the main goal of TEVAR is the exclusion of the aneurysm to prevent aneurysm rupture. Aneurysms with a diameter of 6 cm or more are considered to have a rupture risk of 10% to 15% and thus should be treated. Additional indications for DTA aneurysm repair include symptomatic and rapidly growing aneurysms as well as aneurysms with a saccular configuration.
Procedure
Case Presentation
A 77-year-old patient presented with a 78-mm aneurysm of the DTA, increasing more than 10 mm in diameter in 1 year ( Fig. 14.1 ). The patient had an open repair of an infrarenal abdominal aneurysm with a tube graft in 1998. A common iliac artery aneurysm on the right side had been treated by resection and interposition of a polyester prosthesis in 2005. In 2012 the patient underwent coronary artery bypass graft implantation for three-vessel coronary artery disease. Other relevant comorbidities were congestive heart failure, arterial hypertension, and a history of prostate cancer.
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