The recent development of aortic
stent-grafts has brought the management of thoracic
aortic diseases into the realm of interventional radiology.
Stent-graft placement is now an alternative to surgery for the treatment of descending
thoracic aortic aneurysms,
ulcers, and
fistulas and is sometimes indicated in cases of
mycotic aneurysm, posttraumatic
aortic rupture, or thoracic descending
aortic dissection. Pretreatment imaging is crucial for evaluating patient eligibility, selecting the appropriate
stent-graft, and planning the intervention.
Stent-graft treatment of long atherosclerotic
aneurysms, lesions close to aortic branch vessels, and
aortic dissections is subject to technical pitfalls, and adverse events such as
endoleaks,
stent migration or misplacement, aortic perforation, and vascular
trauma will require specific interventions, although they occur in only a minority of patients. Thoracic
stent-graft placement in good surgical candidates remains controversial because long-term results are unknown. However, short-term morbidity and mortality rates from endovascular treatment compare favorably with those from surgery, and
stent-graft placement is proving to be a safe, minimally invasive, and effective treatment for thoracic
aortic diseases and is already the best option in many affected patients who are poor surgical candidates.