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Descending Thoracic Aneurysm TEVAR — EECC MCQ

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ModerateAortic DiseaseDescending Thoracic Aneurysm TEVAREECC

A 65-year-old man with a descending thoracic aortic aneurysm of 58 mm (growing 5 mm/year) is assessed. He has a history of COPD with FEV1 35% predicted. The aneurysm is anatomically suitable for TEVAR with adequate landing zones. What is the recommended intervention?

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Correct answer: E — TEVAR is recommended for descending thoracic aneurysms ≥55 mm (or growing >5 mm/year) and is particularly advantageous over open repair in patients with significant comorbidities like severe COPD

The ESC 2024 Aortic Disease Guidelines recommend intervention for descending thoracic aortic aneurysms at ≥55 mm (or at smaller sizes if rapid growth >5 mm/year, connective tissue disease, or saccular morphology). TEVAR is the preferred approach for descending thoracic pathology when anatomy is suitable (adequate proximal and distal sealing zones ≥20 mm, suitable access vessels), as it avoids thoracotomy, aortic cross-clamping, and the associated morbidity (paraplegia risk ~3% for TEVAR vs ~5-8% for open repair, lower respiratory complications). This patient with severe COPD (FEV1 35%) would have prohibitive surgical risk for open repair, making TEVAR the clear choice. Long-term surveillance for endoleak is required after TEVAR.

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