Thoracic Aortic Aneurysm

in Thoracic and Complex Aortic Disease

Applied

Type

Modification

Confidence

92%

Created

Apr 15, 2026

Evidence

1 source

Rationale

The ESVS 2026 guidelines (PMID 41448425) directly supersede the Riambau 2017 ESVS guidelines for the same claims about TEVAR as the preferred approach for descending thoracic aortic aneurysms. Per the stale guideline replacement instructions, riambau 2017 has been replaced with European Society for Vascular Surgery (ESVS) rather than co-cited, as both support the same recommendation and there is no materially distinct claim requiring retention of the older citation. The rest of the section content and structure is preserved unchanged.

Evidence

ESVS. European Society for Vascular Surgery (ESVS) 2026 Clinical Practice Guidelines on the Management of Descending Thoracic and Thoraco-Abdominal Aortic Diseases. Eur J Vasc Endovasc Surg. 2025. PMID: 41448425. DOI: 10.1016/j.ejvs.2025.12.050.

These 2025 ESVS clinical practice guidelines provide comprehensive and up to date advice to physicians and patients on the management of diseases of the mesenteric and renal arteries and veins.

Verified source
PubMedDOISource

Content Changes

* **Descending [[TAA]]:** thoracic endovascular aortic repair (TEVAR) is preferred in suitable anatomy, especially in older/high-risk patients; open repair remains for unsuitable anatomy or infection.
* **Ascending/arch:** Managed with open or hybrid strategies; branched/fenestrated arch endografts are emerging but limited to select anatomy/centers.
* **Thresholds:** Consider repair at ≥6.0 cm for descending [[TAA]] (≥5.5 cm with risk factors) and ≥5.5 cm for ascending/arch (lower thresholds with bicuspid valve and risk factors or genetic aortopathy); index to body size in small patients. Connective tissue disorders warrant earlier repair and avoidance of TEVAR when durable proximal/distal fixation is not achievable.
* **LSA management:** In TEVAR, intentional LSA coverage may be required; plan revascularization electively when possible to mitigate stroke/SCI/arm ischemia.

Landmark endograft studies and contemporary society guidelines support TEVAR as the preferred approach for many descending thoracic aneurysms in appropriate anatomy, while emphasizing individualized threshold selection and connective tissue disorder considerations. [@dake1994] [@fairman2008] [@riambau2017][@esvs2025] [@isselbacher2022]
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