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Endovascular management of acute thoracic aortic emergencies

Burgo Jansen, Jim Reekers, Bert Jan van den Born and Loes Oskam

Acute emergencies involving the descending thoracic aorta, such as traumatic aortic disruption (TAD), ruptured descending thoracic aneurysm (RDTA), complicated type B dissection (cTBD), have been particularly challenging for aortic surgeons. Many patients do not survive the initial event, and are never afforded the opportunity to undergo surgical repair. Emergent open operative repair of the descending thoracic aorta, the traditional gold standard, is a formidable undertaking with significant operative mortality and morbidity. These are some of the most difficult and highest risk procedures performed by vascular surgeons. Since the approval of the first thoracic endograft in 2005, thoracic endovascular aortic repair (TEVAR) has quickly become the treatment of choice for elective thoracic aortic aneurysm repair. It was not long before the “off-label” use of TEVAR for a wide variety of conditions, both elective and emergent, was reported. The expanded use of TEVAR has resulted in a decrease in both operative mortality and morbidity for patients with a wide variety of aortic pathologies. In addition, hospital length of stay is usually less following TEVAR, especially if the procedure is done using a totally percutaneous technique.