1. TAA Incidence: – TAA is diagnosed in approximately 15,000
to 25,000 people in the US annually ¹´²
– Incidence is increasing due to :
• Aging population (increased prevalence)
• Increased access to sophisticated imaging
Annual Incidence in Bulgaria:
Ao dissection annual 13/
(approx 1000 cases, 300 TAA/year) (prof. Nacheff PhD thesis)
1.Vascular Web. Available at: Accessed July 31, 2006
2.Bickerstaff LK, Pairolero PC, Hollier LH, et al. Thoracic aortic aneurysms: a population-based study. Surgery 1982;92(6):
3.Garrett HE. Getting started with thoracic endografting. Endovascular Today 2005;1(11):Supplement:13-14.

2. TAA Facts
Mortality: 6,000 deaths annually due to
TAA ²
• 5-year Survival (untreated patients):
19 to 39%
• Annual procedures volume: >18,000
thoracic aortic repair procedures
2. Bickerstaff LK, Pairolero PC, Hollier LH, et al. Thoracic aortic aneurysms: a population-based study. Surgery 1982;92(6):
3.Garrett HE. Getting started with thoracic endografting. Endovascular Today 2005;1(11):Supplement:13-14.

3. Although there are frequently no symptoms, TAA symptoms may include:
Neck, chest or back pain (25%)
Shortness of breath
Difficulty swallowing
Hoarse cough
Congestion of head, neck, upper extremities (related to SVC compression)

4. Abdominal Aortic aneurysm
Affects 4-8% of elderly males
15,000 deaths per year USA
Screening and reduction of elderly male smokers reduces aneurysm related mortality by 46%
USPHTF Ann Int Med Feb 2005

5. TREATMENT OPTIONS
TAAs under 5.0 cm: medical therapy, monitor annual growth by CT
TAAs over 5.0 cm in diameter: intervention/repair strongly considered
Medical management (BP-lowering drugs)
Open surgery
Endovascular repair
No proven lifestyle changes can decrease the size of TAAs.

6. Anatomic Criteria Proximal neck length >15mm diameter <28mm
Tube graft: distal cuff length >10mm diameter <28mm
Iliac artery diameter >7mm and < 15mm
Minimal to moderate tortuosity
No mural thrombus at attachment sites
Minimal calcification
No associated mesenteric occlusive disease

7. AAA: Assessment
Landing zone >2 cm

9. Maintaining Branch Vessel Patency
Fenestrated Endografts
Branched Endografts

10. No landing zone Solution?
Hybrid approach- surgery and endovascular or
Cardiatis?

14. Cardiatis

16. Patient whit Aortic Dissection Stanford Type А
Patient whit Aortic Dissection Stanford Type А. After surgical repair of Ao Asc. whit visceral and periphery ischemia implanted Cardiatis in thoracic Ao

17. Case presentation H.T.H.; 75 year old male;
with a history of an asymptomatic abdominal aortic aneurysm
Comorbidities: Coronary Artery Disease- 2vessel disease. PCI + stent x3 in the RCA. And PCI and stent in RIM. Periphery Artery Disease II st. Arterial Hypertension III gr. Operation due to Ca recti.

18. Aortography

19. CT- angio
SMA

20. Celiac Trunk

21. CT- angio RR
SMA

22. Case presentation 68 –male; V.E.F.
with a history of an asymptomatic abdominal aortic aneurysm.
Comorbidities- Coronary Artery Disease-1vessel disease. PCI + stent in the LCx. Periphery Artery Disease II st. Chronic thrombosis of AFS dex. and a. tibialis post sin et a. perinea sin.
Arterial Hypertension III gr. Gout/ Podagra/ Diverticulosis sygmae. Steatosis hepatis. Ptosis renis sinistra.
In october 2012 CT was performed with evidence for abdominal aortic aneurysm.

23. Aortography TAAA

24. Aortography Abd.A

25. CT- angio

26. CT- angio
IMA LR