ESVS publishes new descending thoracic aortic disease guidelines


Updated European Society for Vascular Surgery (ESVS) clinical practice guidelines regarding the management of diseases of the descending thoracic aorta have been published in the European Journal of Vascular and Endovascular Surgery.

Chaired by Vincent Riambau, Barcelona, Spain, the Descending Thoracic Aorta Writing Committee was appointed by the ESVS to produce new guidelines for surgeons and other physicians involved in the overall care of patients with descending thoracic aortic disorders. The Committee writes, “The goal of these guidelines is to summarise and evaluate all current available evidence to assist physicians in selecting the best management strategies for all descending thoracic aorta pathologies. However, each respective physician must make the ultimate decision regarding the particular care of an individual patient.”

The Committee was formed by members of the ESVS from several different European countries, various academic and private hospitals, and by both vascular surgeons and endovascular specialists, to “maximise the applicability of the final guidelines document”. The Committee first met in November 2011.

The authors write, “The present guidelines document aims to improve decision making and decrease variability in the vascular surgical care of patients presenting with pathology of the descending thoracic aorta. Unfortunately, robust evidence from prospective and randomised studies is not available for management of most descending thoracic aorta diseases. Consequently, the recommendations in these guidelines are entirely based on level B and C evidence. Nevertheless, when managing descending thoracic aorta pathology, it is clinically helpful to have access to the most recent and best available clinical and experimental knowledge to determine the current standard of care.”

The Committee notes that it intentionally agreed to exclude pathology of the ascending aorta and aortic arch from this document, in order to avoid potential inter-specialty conflict. The cost analysis of different treatments was also excluded because of differences in financial management and differing health systems across Europe. Primarily infectious or mycotic disease processes were also considered outside of the scope of these guidelines because of their low incidence and poor outcomes.

All disorders originating in the descending thoracic aorta from the left subclavian artery origin to the diaphragm were considered for these guidelines, with pathology involving the thoracoabdominal segment of the aorta also included.

The new guidelines can be accessed here.