Endovascular repair of thoracoabdominal aortic aneurysms in the 21 st century

Over the last two decades, there have been dramatic advancements in fenestrated and branched technology for endovascular repair of the thoracoabdominal aorta. The global development of these minimally invasive techniques decreased their short-term morbidity and mortality, compared to open aortic replacement. However, the need for secondary reinterventions remains frequent, although they are typically percutaneous. Continual device modifications, improved implantation techniques, and greater understanding of the endovascular tenets constantly improve rates of long-term success. Challenges exist in endovascular repair of post-dissection thoracoabdominal aortic aneurysms (PD TAAAs) with narrow paravisceral true lumen, and our institutional experience evolved from fenestrated to inner/outer branched technology to mitigate the long-term risk of target vessel instability. Refined strategies in bridging stent grafts, particularly in target vessels off the false lumen, lowered target vessel reintervention rates. Prophylactic and therapeutic management of the false lumen is essential to prevent continued aortic degeneration and to mitigate the risk of spinal cord ischemia. Over the next decade, endovascular management of PD TAAAs will continue to evolve, further improving long-term outcomes.