Editor's Choice – Management of Descending Thoracic Aorta Diseases


The European Society for Vascular Surgery (ESVS) appointed the Descending Thoracic Aorta (DTA) Writing Committee (WC) to produce the current clinical practice guidelines document for surgeons and other physicians who are involved in the overall care of patients with DTA disorders. The goal of these guidelines is to summarize and evaluate all current available evidence to assist physicians in selecting the best management strategies for all DTA pathologies. However, each respective physician must make the ultimate decision regarding the particular care of an individual patient.

The present guidelines document aims to improve decision making and decrease variability in the vascular surgical care of patients presenting with pathology of the DTA. Unfortunately, robust evidence from prospective and randomized studies is not available for management of most DTA diseases. Consequently, the recommendations in these guidelines are entirely based on level B and C evidence. Nevertheless, when managing DTA pathology, it is clinically helpful to have access to the most recent and best available clinical and experimental knowledge to determine the current standard of care.

The DTA WC intentionally agreed to exclude pathology of the ascending aorta and aortic arch from the current document to avoid potential inter-specialty conflict. The cost analysis of different treatments was also excluded because of differences in financial management and differing health systems across Europe. Primarily infectious or mycotic disease processes were also considered outside of the scope of this document because of their low incidence and poor outcomes.

All disorders originating in the DTA from the left subclavian artery (LSA) origin to the diaphragm were considered for these guidelines. Pathology involving the thoraco-abdominal segment of the aorta was also included.

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Eur J Vasc Endovasc Surg. 2017 Jan;53(1):4-52.