Treatment selection for thoracoabdominal aortic aneurysm repair: open or endovascular?

Abstract

Despite advancements in operative techniques and perioperative management, early mortality and morbidity from open thoracoabdominal aortic aneurysm (TAAA) repair remain significant. Endovascular aortic repair (EVAR), with visceral parallel grafts or branched/fenestrated stent grafts, is the less invasive treatment option. However, off-the-shelf, branched/fenestrated stent grafts are currently not readily available on the market. The anatomical complexities of TAAAs, which make open repair difficult, such as the involvement of visceral branches and spinal cord blood supplies, are also challenges to endovascular repair. Open surgical TAAA repair should be considered in patients with connective tissue disorders, younger age (less than 50 years old), and ruptured hemodynamically unstable TAAA. Endovascular TAAA repair should be considered in patients with sarcopenia, advanced age, renal dysfunction, and lung dysfunction, if patients have suitable anatomy. The two approaches should remain complementary. Overall, few data exist on which TAAA patient population would benefit from open vs. endovascular approaches. Therefore, this manuscript discusses patient selection for open and endovascular repair of TAAA from a literature review and our institutional experience.

Keywords

Thoracoabdominal aortic aneurysm / TAAA / open repair / endovascular aortic repair / EVAR

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