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TEVAR for Thoracic Aortic Emergency — EECC MCQ

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ModerateAortic DiseaseTEVAR for Thoracic Aortic EmergencyEECC

A 72-year-old man with a known 5.0 cm descending thoracic aortic aneurysm presents with acute worsening back pain. CT shows the aneurysm is now 5.8 cm with a contained rupture (periaortic haematoma without free rupture). He is haemodynamically stable. What is the recommended intervention?

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Correct answer: C — Emergency TEVAR (thoracic endovascular aortic repair) if anatomy is suitable; this is the preferred approach for descending thoracic aortic emergencies given lower morbidity than open surgery

Contained rupture of a descending thoracic aortic aneurysm is a surgical emergency. TEVAR is the preferred interventional approach (when anatomy permits) due to significantly lower perioperative morbidity and mortality compared with open surgical repair via thoracotomy (INSTEAD, ADSORB data). The ESC Aortic Disease Guidelines recommend TEVAR for complicated descending thoracic pathology (Class I). Endovascular criteria include: adequate proximal and distal landing zones (≥20 mm), suitable access vessels, and absence of connective tissue disease (relative contraindication for TEVAR). A contained rupture (periaortic haematoma without free intrapleural rupture) is temporising but can progress to free rupture at any time, mandating urgent intervention.

Reference: ESC (2024): Guidelines for Peripheral Arterial and Aortic Diseases