Who Repairs Descending Thoracic Aortic Aneurysms
Descending thoracic aortic aneurysms are primarily repaired by vascular surgeons or cardiothoracic surgeons at specialized high-volume aortic centers with multidisciplinary teams. 1
Specialist Selection and Referral
Patients with descending thoracic aortic aneurysms meeting intervention criteria must be referred to specialized aortic centers with multidisciplinary aortic teams, as outcomes are significantly improved at high-volume centers with experienced surgeons. 1 The complexity of these repairs demands expertise in both open surgical techniques and endovascular approaches. 1
Primary Specialists Involved:
Vascular surgeons perform the majority of thoracic endovascular aortic repairs (TEVAR), which has become the preferred approach for degenerative or traumatic descending thoracic aneurysms when anatomically feasible. 2, 3
Cardiothoracic surgeons perform open repairs, particularly for patients with connective tissue disorders (where TEVAR is contraindicated), anatomically unsuitable cases, or when open repair is preferred based on patient-specific factors. 1, 2
Treatment Approach Selection
The choice between endovascular and open repair determines which specialist leads the procedure:
TEVAR (Vascular Surgery-Led):
TEVAR is the preferred intervention for degenerative or traumatic descending thoracic aortic aneurysms exceeding 5.5 cm when anatomically feasible, given its reduced morbidity, shorter hospital stay, and lower short-term mortality compared to open repair. 2, 3 This approach is typically performed by vascular surgeons with endovascular expertise. 3
Open Repair (Cardiothoracic Surgery-Led):
Open repair is recommended for patients with connective tissue disorders (Marfan, Loeys-Dietz, Ehlers-Danlos) where TEVAR is contraindicated, as well as for patients unsuitable for TEVAR due to anatomic constraints. 1, 2 Cardiothoracic surgeons perform these complex open procedures using techniques including cardiopulmonary bypass, hypothermic circulatory arrest, and cerebrospinal fluid drainage. 1
Critical Considerations
TEVAR is generally avoided and contraindicated for elective intervention in patients with genetically mediated aortic disorders due to fragile tissue and high failure rates. 1, 2 These patients require open surgical repair by experienced cardiothoracic surgeons. 1
For thoracoabdominal aneurysms extending into the descending thoracic aorta, the repair may require staged procedures or hybrid approaches involving both vascular and cardiothoracic surgical expertise. 1
The key determinant is not just the specialist's training background, but their experience at a high-volume aortic center where multidisciplinary teams can optimize patient selection, procedural technique, and perioperative management. 1