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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2015 December;22(4):223-35
Thoracoabdominal aortic aneurysms: open surgery, chimps, and fenestrated/branched endografts
Eagleton M. J.
Cleveland Clinic Lerner College of Medicine, OH, USA
Thoracoabdominal aortic aneurysms (TAAA) are a life-threatening condition with limited medical therapies. The risk with these aneurysms is that they frequently remain undetected until presenting with rupture, and the mortality associated with this complication is extraordinarily high. The key to overcoming this devastating outcome is to identify those patients with aneurysms that have progressed to a large enough size that the risk of rupture surpasses the risk of repair. Conventional open repair has remained the gold-standard for repair of TAAA, but it carries with it a high morbidity. In addition, given the extent of the procedures, many patients with TAAA are excluded due to their inability to tolerate the physiologic challenge associated with repair. With the evolution of endovascular therapies, several less invasive approaches have become available to treat TAAA. Parallel endografts provide a potential “off-the-shelf” option. Its application, however, has been limited to a small series of patients without long-term follow up that would provide durability information. In addition, fenestrated/branched endograft (F/B-EVAR) has been applied to a much larger set of patients, and results suggest this may provide a viable option in high risk patients. The downside is the current need for customization and higher rates of reintervention when compared to open surgery. Increased experience in endovascular approaches is necessary to assess whether these technologies can be applied to all patients with TAAA, and to better determine which patients may benefit most.