Management of Descending Thoracic Aortic Diseases: Similarities and Differences Among Cardiovascular Guidelines

J Endovasc Ther. 2021 Apr;28(2):323-331. doi: 10.1177/1526602820987808. Epub 2021 Jan 13.


Cardiovascular societies have developed recommendations regarding the management of thoracic aortic diseases. While improvements in treatment have been observed during the past decade in regard to patient selection, thoracic endovascular aortic repair (TEVAR) and associated techniques, and high-volume centralization, the broad expansion of TEVAR has raised considerations about its indications, appropriateness, limitations, and application. The aim of this systematic review was to assess the similarities and differences among current cardiovascular societies' guidelines for the management of thoracic aortic diseases. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from January 2009 to May 2020. The initial search identified 990 articles. After exclusion of duplicate or inappropriate articles, the final analysis included 5 articles from cardiovascular societies published between 2010 and 2020. Selected controversial topics were analyzed, including diagnosis, imaging, spinal cord ischemia prevention, and management of the most important thoracic aortic pathologies. The analysis included data concerning the therapeutic approach in acute and chronic type B aortic dissection, penetrating aortic ulcer, intramural hematoma, thoracic aortic aneurysm, and traumatic aortic injury, as well a discussion of inflammatory aneurysms, aortitis, and genetic syndromes. The review presents consistent and controversial recommendations, as well as "gray zone" issues that need further investigation. There was significant overlap and agreement among the 5 societies regarding the management of thoracic aortic diseases. Especially in dissection and aneurysm management, TEVAR has established its role as the treatment of choice. However, robust evidence is still needed in many aspects of the management of thoracic aortic pathologies.

Keywords: cardiovascular societies; diagnostic methods; endoleak; imaging; open repair; practice guidelines; screening; surgery; thoracic aortic aneurysm; thoracic aortic diseases; thoracic aortic dissection; thoracic endovascular aortic repair.

Publication types

  • Systematic Review

MeSH terms

  • Aorta, Thoracic / diagnostic imaging
  • Aorta, Thoracic / surgery
  • Aortic Aneurysm, Thoracic* / diagnostic imaging
  • Aortic Aneurysm, Thoracic* / surgery
  • Aortic Diseases* / diagnostic imaging
  • Aortic Diseases* / surgery
  • Aortic Dissection* / diagnostic imaging
  • Aortic Dissection* / surgery
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Endovascular Procedures* / adverse effects
  • Humans
  • Retrospective Studies
  • Treatment Outcome