Endovascular repair of type II and type III thoracoabdominal aneurysms

Thoracoabdominal aortic aneurysms (TAAA) remain a challenging problem to manage. Operative care for patients afflicted with this devastating problem is associated with significant risks, including renal failure and paraplegia. Several techniques have been developed to help limit the risk for these complications, yet they still remain some of the greatest hurdles associated with these procedures. Endovascular technology is rapidly advancing and may provide an alternate approach to patients with TAAA. Endograft treatment of TAAA is possible with the use of fenestrated and/or branched aortic endografts. Although still early in its evolution, we are beginning to understand some of the risks and benefits of this approach to complex aortic disease. Fenestrated and branched aortic endografting may provide an option that has lower risk to patients. Spinal cord ischemia, however, still remains a critical problem in patients who require treatment of a significant portion of their aorta. In addition, renal failure is also still observed. The mechanisms leading to the development of these complications following endograft repair, however, may not be the same as observed with open TAAA repair. This review will highlight some of our current understandings of endovascular repair of thoracoabdominal aortic aneurysms.