Thoracoabdominal Aortic Aneurysm or Dissection developed for some patient groups including hybrid repair and entirely endovascular repair. In hybrid repair, a combination of surgical and endovascular techniques is used, often in a staged format, with techniques including abdominal debranching followed by thoracic endovascular repair. Hybrid repairs showed favorable results in several series, although with aortic related mortality rates of 9%, 14%, and 14% at 1, 2, and 5 years, respectively, in one study [6-8]. More recently, a number of endovascular techniques have been used for repair, including thoracic EVAR, EVAR with parallel (eg, chimney/snorkel) stents into the branch artery, fenestrated EVAR, and branched EVAR [9-12]. Multiple studies have found encouraging results in terms of technical success, intraprocedural mortality, and branch vessel patency, although with high rates of reintervention for endoleaks [10,13-16]. Similarly, techniques for endovascular treatment of type B dissection have also been refined over the past decades, with new innovations in treating type A dissection emerging as well. The decision of surgical versus hybrid or endovascular repair is based on the characteristics of the aneurysm or dissection, along with factors such as suitability for surgery and patient preference. Regardless of type of treatment, postprocedural surveillance is important because patients with poor compliance with follow-up imaging are found to have higher rates of aortic rupture [17]. Special Imaging Considerations As MRI technology and sequences have continued to improve, multiple new sequences and protocols have been developed for assessment of the aorta. In particular, sequences aimed at evaluating flow dynamics and aortic wall stress have been used to predict aneurysm growth [19-24].
Thoracoabdominal Aneurysm or Dissection Treatment Planning and Follow Up. Thoracoabdominal Aortic Aneurysm or Dissection developed for some patient groups including hybrid repair and entirely endovascular repair. In hybrid repair, a combination of surgical and endovascular techniques is used, often in a staged format, with techniques including abdominal debranching followed by thoracic endovascular repair. Hybrid repairs showed favorable results in several series, although with aortic related mortality rates of 9%, 14%, and 14% at 1, 2, and 5 years, respectively, in one study [6-8]. More recently, a number of endovascular techniques have been used for repair, including thoracic EVAR, EVAR with parallel (eg, chimney/snorkel) stents into the branch artery, fenestrated EVAR, and branched EVAR [9-12]. Multiple studies have found encouraging results in terms of technical success, intraprocedural mortality, and branch vessel patency, although with high rates of reintervention for endoleaks [10,13-16]. Similarly, techniques for endovascular treatment of type B dissection have also been refined over the past decades, with new innovations in treating type A dissection emerging as well. The decision of surgical versus hybrid or endovascular repair is based on the characteristics of the aneurysm or dissection, along with factors such as suitability for surgery and patient preference. Regardless of type of treatment, postprocedural surveillance is important because patients with poor compliance with follow-up imaging are found to have higher rates of aortic rupture [17]. Special Imaging Considerations As MRI technology and sequences have continued to improve, multiple new sequences and protocols have been developed for assessment of the aorta. In particular, sequences aimed at evaluating flow dynamics and aortic wall stress have been used to predict aneurysm growth [19-24].