Endovascular management options and techniques for ruptured thoracoabdominal aortic aneurysm

Abstract

Objective

Open surgical repair of ruptured thoracoabdominal aortic aneurysms (rTAAAs) carries significant risk of mortality and morbidity; in recent years, endovascular repair has emerged as a suitable alternative. This article aims to review currently available technologies, techniques, and outcomes for endovascular repair of rTAAA.

Methods

A narrative review of current literature was performed.

Results

Off-the-shelf branched endografts are available and are often the first-line endovascular therapy for types I, II, and III rTAAA or type IV rTAAA with a lumen diameter ≥24 mm at the level of the renovisceral vessels. In patients with anatomy unsuitable for off-the-shelf branch devices, particularly those with ruptured type IV or pararenal TAAA with a narrow aortic lumen, endovascular repair with in situ laser fenestration is a reasonable alternative. Physician-modified devices as well as endovascular repair with parallel stent grafts (chimney, periscope, sandwich, or Octopus) have been described by select centers with satisfactory outcomes.

Conclusions

Patients with rTAAA and suitable anatomy who are at high or prohibitive surgical risk can be managed endovascularly with comparable outcomes. Various techniques are described in the literature, and the choice of technique used should depend on patient anatomy and surgeon expertise.