Endovascular management of emergent thoracic aortic pathologies

Abstract

The introduction of thoracic endovascular aneurysm repair (TEVAR) in 2005 facilitated a minimally invasive treatment alternative for complex thoracic aortic pathologies. Symptomatic descending thoracic aortic aneurysm, complicated Stanford type B aortic dissections, and traumatic aortic transections are emergent pathologies that are associated with substantial morbidity, mortality, and a risk of postoperative paraplegia following conventional open reconstruction via thoracotomy and graft replacement. This chapter describes three emergent cases involving the descending thoracic aorta managed endovascularly. We also describe the adjunctive use of intravascular ultrasound (IVUS) to assure accurate aortic measurements and precise TEVAR endoprosthesis placement. TEVAR technology has allowed us to develop rapid and minimally invasive treatment alternatives for these devastating aortic injuries.