Epidemiología, diagnóstico, clasificación e indicaciones quirúrgicas actuales de los aneurismas de la aorta toracoabdominal

Thoracoabdominal aortic aneurysms remain a challenge in cardiovascular surgery due to the complexity of the pathology, the invasiveness of surgical treatment required and common patient comorbidities. The prevalence, true and detected, of these aneurysms has increased due to increased life expectancy, improved diagnosis, and greater physician and patient awareness. They can trigger dissection or rupture, and half of all deaths are due to aortic rupture, even in aneurysms with diameters under 6 cm. The goal of treatment is to reduce the risk of adverse aortic events, such as dissection, rupture, or aortic-related death. The timing of intervention requires careful evaluation of anatomic and risk factors for future events versus operative risks. Open surgery aims to replace the aneurysmal thoracoabdominal aortic segment with a prosthetic graft anastomosed to adjacent non-aneurysmal aortic tissues, whereas endovascular repair uses stent-grafts to exclude blood flow from the aneurysmal sac. The morbidity and mortality of open surgical repair are high, especially in patients with comorbidities, and include spinal cord ischemia and renal damage. Endovascular treatment has been developed as a less invasive alternative to open surgery, with promising results in reducing hospital mortality, but its use remains experimental. The choice of treatment requires a multidisciplinary assessment of the patient's risk factors and the anatomical characteristics of the aneurysm. Hybrid treatment, combining thoracic endovascular repair with (simultaneous or deferred) open abdominal surgery, has recently been proposed, but there is still limited experience and no robust evidence for improved outcomes.