Thoracoabdominal aortic aneurysm repair

Because of the aging population, the incidence of thoracoabdominal aortic aneurysms (TAAAs) will increase in the next decades. These aneurysms constitute a highly lethal disease, therefore requiring treatment to prevent rupture and subsequent death. However, open surgery comprises substantial morbidity (cardiac events, pulmonary complications, renal failure, paraplegia) and mortality, necessitating extensive preoperative risk evaluation. The surgical results of TAAA repair have significantly improved during the last two decades, mainly because of adjunctive measures such as left heart bypass, cerebrospinal fluid drainage, and spinal cord monitoring. Descending thoracic aneurysms are increasingly being treated by means of endovascular techniques. Endovascular repair of TAAAs with side-branch technology has recently begun, and with future technological innovation, this approach will determine future strategies. Meanwhile, hybrid procedures combining open and endovascular techniques will decrease the extent of surgical trauma. Long-term assessment will be necessary to establish the safety and efficacy of endovascular modalities. At present, open surgery is still the gold-standard treatment for TAAA, especially in (relatively) young patients with Marfan syndrome.