Role of endovascular therapies in the management of diverse thoracic aortic pathology.

Stent grafts are currently indicated for treatment of chronic aneurysmal disease of the descending thoracic aorta. At most centers of excellence, this technique has become the preferred treatment modality for this pathologic process. Many centers are also reporting excellent outcomes using a variety of debranching procedures to expand the anatomic limits of therapeutic intervention. These debranching procedures enable proximal extension of stent grafts into the transverse aortic arch and similarly enable distal extension into the visceral portion of the abdominal aorta. Thoracic aortic disease, however, is not limited to aneurysmal pathology. In our experience, at least half of all patients with major thoracic aortic pathology will have nonaneurysmal disease processes. Frequently, these patients are high-risk candidates for the performance of open surgical intervention. The reduced procedural morbidity and mortality observed with thoracic endovascular aortic repair when compared with open surgical intervention have catalyzed the investigation of stent grafts in the management of nonaneurysmal pathologic processes. This therapy has been successfully applied to a variety of diverse thoracic aortic pathologies, including aortic dissection, aortic transection, penetrating atherosclerotic ulcers, embolic lesions, and aortic coarctation. The focus of this article is on the latter 3 of these pathologies.