Beyond the Arch: Evolving Strategies in the Surgical Management of Complex Thoracic Aortic Disease
Overview of Thoracic Aortic Complexity Complex thoracic aortic disease refers to conditions affecting multiple or difficult-to-access segments of the thoracic aorta, such as the ascending aorta, arch, and descending thoracic region. These diseases include extensive aneurysms, chronic dissections, traumatic transections, and genetically driven pathologies like Marfan or Loeys-Dietz syndromes. Surgical treatment of these disorders requires intricate planning, advanced technical skill, and often, multimodal interventions to minimize risk and maximize long-term success. Over the last decade, treatment paradigms have shifted from purely open approaches to more nuanced, hybrid, and endovascular strategies. These approaches have improved the safety and durability of repair in a patient population that is increasingly older and medically complex. Diagnostic Precision and Surgical Timing An accurate diagnosis begins with high-resolution imaging—typically contrast-enhanced computed tomography a...