The European Society for Vascular Surgery (ESVS) has released updated clinical practice guidelines for the care of patients with descending thoracic and thoracoabdominal aortic pathologies. The document, which is currently available as an article in press in the society’s dedicated journal, provides a “comprehensive and fully updated revision” of recommendations published by the ESVS in 2017.
Authors Anders Wanhainen (Uppsala University, Uppsala, Sweden and Umeå University, Umeå, Sweden) and colleagues write in the European Journal of Vascular and Endovascular Surgery (EJVES) that they have issued 129 recommendations, including 42 graded Class I, across several key topics: acute thoracic aortic syndrome, chronic type B aortic dissection, descending thoracic and thoracoabdominal aortic aneurysms, ruptured descending thoracic and thoracoabdominal aortic aneurysms, and blunt aortic injury.
Wanhainen and colleague note that every section of the 2017 guidelines has been either revised or rewritten “to reflect the rapid technological advances in the field over the past decade”.
The authors write that, as a whole, the 2026 guidelines emphasise an endovascular-first paradigm wherever anatomy permits, reflecting the central role of fenestrated and branched techniques in contemporary practice. They also underline the importance of multidisciplinary care, promoting centralised treatment in high-volume aortic centres and structured team-based decision making.
Furthermore, the authors note that quality assurance is reinforced through recommendations on registry participation, standardised outcome reporting, and continuous quality improvement.
A greater focus is placed on patient-centred care, Wanhainen and colleagues add, with an emphasis on incorporating patient perspectives, shared decision making, and tailoring interventions to life expectancy and functional status.
The document closes with a section on unresolved issues regarding the management of thoracic and thoracoabdominal aortic diseases, with the authors highlighting a lack of high-quality evidence in the field as a “fundamental challenge”.
“The field urgently awaits data from well-designed prospective registries and RCTs [randomised controlled trials],” Wanhainen and colleagues write, pointing out that several such initiatives are already underway.
The authors continue: “In the meantime, the 2026 guidelines aim to mitigate this uncertainty by emphasising individualised, multidisciplinary care in experienced high-volume aortic centres, supported by structured SDM [shared decision making] with patients.”
The authors also encourage active participation in national and international registries “to expand the collective evidence base and improve future guideline development”.
