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Rinaldi et al. Vessel Plus 2024;8:21 https://dx.doi.org/10.20517/2574-1209.2023.65 Page 15 of 19

providing comprehensive, patient-centered care for acute aortic syndromes involving the descending
thoracic aorta, ultimately improving outcomes, and reducing morbidity and mortality associated with these
life-threatening conditions.

Brief general considerations about the endovascular approach in patients with AAS
TEVAR, particularly in cases involving extensive aortic coverage, carries an inherent risk of spinal cord
ischemia (SCI) stemming from the occlusion of a high number of intercostal arteries. When treating
patients with AAS, in urgent or emergent settings, the incidence of this severe complication may escalate
compared to elective procedures. Factors contributing to this heightened risk in acute cases include
hemodynamic instability, longer aortic coverage for effective disease exclusion, non-staged procedures, and
limitations in the usage of the available adjuncts for spinal cord protection. While many risk factors are
non-modifiable preoperatively, it is crucial to emphasize vigilant patient monitoring and prompt
application of available tools to prevent or mitigate this life-threatening event as swiftly as possible [74-77] .

Another important aspect to consider is the incidence of genetically triggered aortic disorders in patients
with AAS, as these conditions inherently elevate the risks of aTBAD, IMH, and aortic rupture in general.
While open surgical approaches may offer superior long-term outcomes in patients with collagenopathies,
TEVAR presents advantages in urgent or emergent scenarios due to its reduced invasive nature.
Consequently, TEVAR is commonly accepted, albeit sometimes viewed as a bridging procedure for
stabilizing patients. For individuals with genetically triggered aortic disorders undergoing endovascular
treatment, rigorous follow-up is imperative to promptly detect, and address, potential complications,
including those requiring surgical intervention .
[78]

CONCLUSIONS
The advent of endovascular treatments has marked a significant advancement in the management of acute
aortic syndromes involving the descending thoracic aorta, often demonstrating superior outcomes
compared to traditional open surgical repair. Nonetheless, it is imperative to acknowledge the inherent risks
and potential complications associated with endovascular techniques, despite their overarching benefits.
Consequently, a meticulous patient selection process is essential to discern the optimal candidates for
endovascular intervention versus those better suited for medical therapy alone.

Vascular surgeons play a pivotal role in this decision-making process, requiring a nuanced understanding of
available therapeutic modalities and the ability to tailor treatment strategies to individual patient profiles
and disease presentations. As the landscape of acute aortic syndrome management continues to evolve,
ongoing research efforts and technological advancements are paramount to further enhancing patient
outcomes and addressing the complexities inherent in these conditions.

Through continuous learning and refinement of techniques, the medical community can progressively
confront and mitigate the challenges posed by acute aortic syndromes, thereby rendering them less
formidable adversaries. Therefore, it is incumbent upon medical professionals to remain abreast of the latest
advancements, guidelines, and evidence-based practices in AAS management to deliver optimal care to
patients.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the study and performed data analysis and
interpretation: Rinaldi E, Mascia D, Campesi C, Pizzutilli AC, Melissano G