Endovascular grafts for thoracic aortic pathologies

Endovascular aortic repair (EVAR) is rapidly being adopted to capture a substantial proportion of surgical candidates with aneurysmal disease of the descending thoracic aorta. This new technique requires both special equipment (hybrid operating room, full range of catheterization tools) and additional technical skills, which an average cardiothoracic surgeon usually lacks, not being exposed to this particular training during his formative years. Presently, EVAR is applied to high-risk surgical candidates, its main advantages being the avoidance of cardiopulmonary bypass, minimal invasiveness (no large incisions) and often the ability to perform the procedure under local anesthesia. Early mortality in the author's (H.S.) institution is comparable to the best surgical results published, which is remarkable with respect to the high-risk patients. The techniques are rapidly being developed, with treatment of the aortic arch aneurysm employing transposition of supra-aortic arteries, and of the thoraco-abdominal aneurysms with branched grafts.