Stent grafts for the thoracic aorta: a new paradigm?

The treatment of thoracic aortic pathology is complicated by the morbidity of the surgical procedure, and the comorbidities encountered in an elderly population. Stent grafts have now been used for approximately 10 years for the treatment of thoracic aneurysmal disease, management of aortic dissections, intramural hematoma, and giant penetrating ulcers, and for traumatic aortic tears, with impressive early results. However, these efforts have been significantly limited by the lack of a commercially available stent graft specifically designed for the thoracic aorta, the lack of real long-term follow-up, and the failure of experience in the abdominal aorta to translate to the thoracic aorta. Nevertheless, significant and even unique therapies have been enabled by stent graft technology for the treatment of the above-mentioned diseases. It is likely that, with more sophisticated technology and improved understanding of thoracic aortic pathology, stent graft use will expand, and its utility will be further clarified.