JACC Focus Seminar: Disease of the Aorta
JACC Focus Seminar
Thoracoabdominal Aortic Disease and Repair: JACC Focus Seminar, Part 3

https://doi.org/10.1016/j.jacc.2021.05.056Get rights and content
Under an Elsevier user license
open archive

Highlights

  • Thoracoabdominal aortic disease is a life-threatening condition that requires expert multidisciplinary collaborative management. Repair is best performed electively by an experienced team.

  • Conventional repair involved open graft replacement, but fenestrated and branched endograft procedures are viable alternatives.

  • Patients with known degenerative thoracoabdominal aortic aneurysms and chronic dissections should be followed up closely with serial imaging and referred for elective repair based on defined diameter thresholds, rate of expansion, or symptoms.

Abstract

Thoracoabdominal aortic disease is a rare but life-threatening condition that requires expert multidisciplinary collaborative management. Intervention is indicated in patients with symptomatic aneurysms or when an aneurysm reaches a certain threshold of diameter or rate of expansion. The strategies for spinal cord and end-organ protection have evolved over several decades, resulting in improved outcomes after repair. Open repair, although invasive, provides definitive and durable repair. Endovascular approaches are rapidly evolving, and the results with fenestrated and branched endografts are promising. Both open repair and endovascular repair require highly specialized expertise, and outcomes are best when repair is undertaken in an elective setting by a dedicated team. Patients with degenerative thoracoabdominal aortic aneurysms and chronic dissections should be followed up closely and referred for elective repair when indicated.

Key Words

aortic aneurysm
dissection
endovascular
thoracoabdominal aneurysm

Abbreviations and Acronyms

CMD
custom-made device
CSF
cerebrospinal fluid
HTAD
hereditary thoracic aortic disorders
PMEG
physician-modified endograft
SCI
spinal cord ischemia
TAAA
thoracoabdominal aortic aneurysm

Cited by (0)

Listen to this manuscript's audio summary by Editor-in-Chief Dr Valentin Fuster on www.jacc.org/journal/jacc.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.