Open and Endovascular Management of Complex Aortic Aneurysms

Dear Colleagues,

Aortic disease is the direct cause of close to 10000 deaths annually in the United States. The goal of aortic aneurysm repair is to prevent the high morbidity and mortality associated with aneurysm rupture.

The decision to treat an AAA is based on the associated risk of treatment, the risk of aneurysm rupture, the patient’s life expectancy, and patient preference. However, the paradigm of open surgical repair (OSR) changed after the introduction of endovascular repair (EVAR). Since then, the use of endovascular techniques in the treatment of aortic aneurysms has expanded dramatically, and EVAR is now the primary treatment for AAA.

While OSR remains an integral part of a comprehensive aortic aneurysm treatment program, rates of open AAA repair have declined dramatically in the endovascular era. Therefore, fewer surgeons and centers have a high-volume open aneurysm practice and the relationship between open AAA repair outcomes and surgeon/center volume is dramatic, particularly for complex AAA, which should be performed by experienced surgeons at high-volume centers.

With this in mind, we have reviewed in this Special Issue the management of complex AAAs, comprising juxtarenal AAAs and suprarenal AAAs, which represent around 15% of AAAs requiring treatment which cannot be repaired with standard EVAR because of the lack of an infrarenal neck. Two techniques (FEVAR and chimney/snorkel EVAR) have been developed to extend the proximal seal zone, allowing for endovascular repair in these patients. This is followed by the management of (1) descending thoracic aneurysms by OSR and by TEVAR, as well as (2) thoracoabdominal and (3) aortic arch aneurysm repair both by OSR and by innovative endovascular techniques.

We believe that this Special Issue will be of interest to readers of the Journal of Clinical Medicine. Endovascular aortic aneurysm repair is now being used in the entire aorta and has allowed definite repair in patients unsuitable for OSR. It has also introduced its own set of complications and challenges.

Prof. Dr. Jean-Baptiste Ricco
Guest Editor

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