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Page 14 of 19 Rinaldi et al. Vessel Plus 2024;8:21 https://dx.doi.org/10.20517/2574-1209.2023.65

Figure 9. (A) Angio-CT scan of a patient with ruptured dissecting thoracic aneurysm (rDTA) and extensive hemothorax. (B) The
patient received TEVAR treatment to exclude the aneurysm. Intentional coverage of the LSA was performed to achieve proper proximal
sealing.

Distal Landing Zone and Visceral Vessels: When the aneurysm extension involves visceral vessels, distal
extension with coverage of the celiac trunk (CT) may be required for endovascular exclusion. This approach
enables patient stabilization and deferral of more intricate procedures. While the safety and efficacy of CT
coverage during thoracic endovascular aortic repair (TEVAR) have been demonstrated, a thorough
evaluation of collateral circulation is imperative. In instances where collateral circulation appears
insufficient during temporary CT occlusion, additional techniques such as chimney grafts, periscopes, or
physician-modified stent-grafts may be considered [70,71] .

Off-the-Shelf Multibranched Stent-Grafts: In urgent or emergent situations where custom-made devices are
unavailable, off-the-shelf multibranched stent-grafts may serve as a viable option for patients with rDTA
involving the thoraco-abdominal aorta. However, this approach necessitates a more intricate endovascular
procedure, sufficient material availability, and expertise. Studies have indicated acceptable morbidity and
[72]
mortality rates with off-the-shelf multibranched stent-grafts, even for ruptured aortic aneurysms .

Individualized Decision-Making: The management of rDTA demands personalized decision-making based
on the patient's clinical status, anatomical considerations, resource availability, and the proficiency of the
medical team.

Multidisciplinary team-led management
Recent evidence underscores the indispensable role of multidisciplinary team-led management in the
treatment of acute aortic syndromes involving the descending thoracic aorta. Collaborative efforts among
cardiovascular surgeons, interventional radiologists, cardiologists, anesthesiologists, and other specialists are
paramount for optimizing patient outcomes . This approach allows for comprehensive evaluation, precise
[73]
diagnosis, and tailored treatment strategies. Studies have shown that multidisciplinary teams lead to more
accurate and timely diagnoses, reducing the risk of misdiagnosis or delayed intervention. Moreover, the
complexity of acute aortic syndromes often necessitates a multifaceted treatment approach, incorporating
different techniques. Multidisciplinary teams facilitate seamless coordination between different specialties,
ensuring that patients receive the most appropriate and effective therapies. Furthermore, they enable
ongoing monitoring and follow-up, essential for long-term management and prevention of recurrence.
Overall, the recent evidence highlights the crucial role of multidisciplinary team-led management in