AHA Issues Scientific Statement on Descending Thoracic Aortic Disease Management

June 29, 2010—In Circulation, Michael A. Coady, MD, et al have published an American Heart Association scientific statement on open and endovascular surgical management of descending thoracic aortic disease (2010;121:2789–2804).

According to the investigators, the purpose of this scientific statement is to present a contemporary review of the various pathological processes that affect the descending thoracic aorta (ie, aneurysms, dissections, intramural hematomas, penetrating atherosclerotic ulcers, and aortic transactions). The statement considers these disorders in detail, with an exploration of the natural history, available treatment options, and controversies regarding management. Current intervention criteria are reviewed with respect to both open surgical repair and endovascular treatment. The investigators' goal is to provide health care professionals with a better understanding of the pathophysiology of the various disease processes that involve the descending thoracic aorta and to review current outcomes and technical pitfalls associated with these therapies to facilitate strong, evidence-based decision making in the care of these patients.

In their conclusions, the investigators stated that treatment of acute aortic syndromes that affect the descending thoracic aorta continues to evolve with the development of new technologies and management strategies. Although the data presented in the summary highlight current outcomes of endovascular stenting compared with conventional open repair, the investigators stressed that there have been no prospective, randomized trials to compare these treatment strategies in a head-to-head manner.

In addition, the investigators commented that although endovascular stenting offers a minimally invasive method of treatment, its long-term durability is still largely unknown. Ongoing experience and national and international registries will continue to define precise roles for both surgical and endovascular therapy. As technology continues to improve and surgeons continue to make strides along the learning curve in treating these diseases, the long-term complications of endografting may or may not be mitigated. Continued vigilant surveillance of those patients treated with an endograft remains important. Finally, the health care provider must constantly evaluate and revisit these data and carefully apply the principles of evidence-based medicine to be able to care for these patients appropriately.