Open and endovascular treatment options in thoracic aortic surgery

Open endovascular and hybrid repairs have recently emerged as a method for treating the different segments of the thoracic aorta. A full or upper-mini median sternotomy is the usual approach for proximal aortic disease and proximal and transverse arch repairs. Other approaches, such as minimally invasive right thoracotomy, have also emerged. Until recently, a left thoracotomy and thoracoabdominal approach has been the sole approach for treating lesions of the descending and thoracoabdominal thoracic aorta. In the 1980s, the first aortic repair with a self-fixing endoprosthesis was performed. In subsequent years, the technique of using a stent graft to treat an abdominal aortic aneurysm, and subsequently thoracic aortic aneurysm, was popularized, followed by extensive development of this technology. The different techniques and modalities for treatment are discussed in this chapter.