Is it time for an endovascular first approach for ruptured thoracoabdominal aortic aneurysms?

Abstract

In their article, Gallitto et al. [1] presented the results of their 10-year experience in the treatment of urgent thoraco-abdominal aortic aneurysms (TAAAs) with an off-the-shelf (OTS) multibranched endograft (Zenith t-Branch, Cook Medical, Bloomington, IN, USA). The authors were able to treat 65 patients with satisfactory early and midterm results. The available literature on the use of OTS devices to treat urgent TAAA is limited but shows promising results. A recent paper from Eleshra et al. [2] showed no differences in technical success between elective and urgent/emergent treatment of TAAA using a t-Branch device, although the latter group presented worse periprocedural morbidity and mortality. In recent years, the treatment paradigm for ruptured abdominal aortic aneurysms (rAAA) has changed as more and more patients are now treated endovascularly (EVAR), which has now become the gold standard of treatment over the open repair (OR) with encouraging early and midterm results in anatomically feasible patients. According to the Guidelines of the European Society of Vascular Surgery, EVAR should be considered in case of rAAA when anatomically feasible [3]. Furthermore, a recent paper comparing 4257 patients receiving either EVAR or, EVAR presented a higher 5-year survival (55% vs 46%; P < 0.001) [4].