Thoracic and Thoracoabdominal Aortic Aneurysms

Just as aortic stent grafts revolutionized infrarenal aneurysm repair, grafts designed for thoracic endovascular aneurysm repair (TEVAR) have substantially changed the treatment algorithm for the multiple disease processes that affect the thoracic aorta since the first thoracic stent graft was approved in 2005 (Cho et al., Semin Vasc Surg 19(1):18–24, 2006). This chapter will review the epidemiology, pathophysiology, clinical presentation, and indications for repair of thoracic (TAA) and thoracoabdominal aortic aneurysms (TAAA). The basic principles of TAA case planning are reviewed and commercially available and investigational stent grafts designed for TAAA repair are introduced. Complications arising from the endovascular treatment of TAA and TAAA can be devastating, and risks must be minimized. The treatment of these complex aneurysms requires a mastery of endovascular and open surgical skills and immediate access to specialized anesthesia, cardiac surgery, and intensive care resources.