Descending Thoracic Aortic Aneurysms

In recent decades, the advent of endovascular technology has considered one of the main medical revolutions, because it changed the current therapeutic paradigm of aortic aneurysms repair. The endovascular repair of thoracic aortic aneurysm (TEVAR), introduced in clinical practice in 1994, is now widely accepted as the gold standard to treat descending thoracic aortic diseases in the presence of anatomical feasibility, due to its lower perioperative mortality and morbidity than open repair (OR) (Riambau et al. Eur J Vasc Endovasc Surg 53:4–52, 2017; Upchurch Jr et al. J Vasc Surg 73:55S–83S, 2021). TEVAR allows a mini-invasive solution (avoiding a thoracotomy and thoracic aortic cross-clamping) in several descending thoracic aortic diseases such as degenerative aneurysms of the thoracic aorta (DTAA), penetrating aortic ulcer, intramural hematoma, and acute/chronic aortic dissection (Riambau et al. Eur J Vasc Endovasc Surg 53:4–52, 2017). In this chapter, we will focus only on the endovascular repair of DTAA.