The Role of Endovascular Treatment in the Management of Aortic Aneurysm, Dissection, and Other Diseases

Endovascular therapy provides a new treatment modality for patients with aortic disease. By avoiding the morbidity of open surgery, endovascular approaches make treatment possible for a larger array of patients. However, the durability and long-term survival benefit of endovascular aortic intervention require further discussion and additional follow-up. We believe that the characterization of the role of endovascular therapy involves close risk-benefit analysis based on patient risk, disease presentation, native and pathological anatomy, and long-term outlook. Through review of the randomized prospective literature and relevant retrospective data, we explore the role of catheter-based solutions in abdominal and thoracic aortic disease, with a focus on aortic aneurysm and aortic dissection (AD). For patients with appropriate anatomy, endovascular aortic repair (EVAR) has largely supplanted open aortic repair (OAR) in the treatment of abdominal aortic aneurysm (AAA), both in the elective setting and during rupture. Similarly, thoracic endovascular aortic repair (TEVAR) has gained popularity in treating disease of the descending thoracic aorta, in both aneurysmal degeneration and AD. Similar adoption has been seen in treating other disease states, namely traumatic aortic injury. However, we recognize the current limitations of endovascular therapy and detail the innovations being pursued to advance endovascular therapy in the future.