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Tanaka et al. Vessel Plus 2023;7:28 Vessel Plus
DOI: 10.20517/2574-1209.2023.108

Review Open Access

Treatment selection for thoracoabdominal aortic

aneurysm repair: open or endovascular?

Akiko Tanaka , Holly N. Smith, Anthony L. Estrera
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth Houston, Houston, TX 77030,
USA.

Correspondence to: Prof. Anthony L. Estrera, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at
UTHealth, 6400 Fannin St., Ste. #2850, Houston, TX 77030, USA. E-mail: Anthony.L.Estrera@uth.tmc.edu

How to cite this article: Tanaka A, Smith HN, Estrera AL. Treatment selection for thoracoabdominal aortic aneurysm repair: open
or endovascular? Vessel Plus 2023;7:28. https://dx.doi.org/10.20517/2574-1209.2023.108

Received: 15 Aug 2023 First Decision: 26 Sep 2023 Revised: 13 Oct 2023 Accepted: 16 Nov 2023 Published: 23 Nov 2023

Academic Editor: Narasimham L. Parinandi Copy Editor: Fangyuan Liu Production Editor: Fangyuan Liu

Abstract
Despite advancements in operative techniques and perioperative management, early mortality and morbidity from
open thoracoabdominal aortic aneurysm (TAAA) repair remain significant. Endovascular aortic repair (EVAR),
with visceral parallel grafts or branched/fenestrated stent grafts, is the less invasive treatment option. However,
off-the-shelf, branched/fenestrated stent grafts are currently not readily available on the market. The anatomical
complexities of TAAAs, which make open repair difficult, such as the involvement of visceral branches and spinal
cord blood supplies, are also challenges to endovascular repair. Open surgical TAAA repair should be considered in
patients with connective tissue disorders, younger age (less than 50 years old), and ruptured hemodynamically
unstable TAAA. Endovascular TAAA repair should be considered in patients with sarcopenia, advanced age, renal
dysfunction, and lung dysfunction, if patients have suitable anatomy. The two approaches should remain
complementary. Overall, few data exist on which TAAA patient population would benefit from open vs.
endovascular approaches. Therefore, this manuscript discusses patient selection for open and endovascular repair
of TAAA from a literature review and our institutional experience.

Keywords: Thoracoabdominal aortic aneurysm, TAAA, open repair, endovascular aortic repair, EVAR

BACKGROUND
Seven decades have passed since the first report of open thoracoabdominal aortic aneurysm (TAAA)

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
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