This year we are starting with new guidelines on the diagnosis, treatment, and follow-up of diseases affecting the descending thoracic aorta and the thoraco-abdominal aorta.

These guidelines, developed by the European Society for Vascular Surgery (ESVS), provide evidence-based recommendations to support clinicians and patients in the diagnosis, treatment, and follow-up of diseases affecting the descending thoracic aorta and the thoraco-abdominal aorta. The document includes 129 recommendations, graded by strength of recommendation and level of evidence. Recommendations are based on systematic literature review and expert consensus. Emphasis is placed on patient-centered care and multidisciplinary decision-making.

The main clinical conditions addresses are

1. Acute Thoracic Aortic Syndromes

  • Early diagnosis and rapid management are essential.
  • Clear guidance on imaging, medical stabilization, and indications for intervention.

2. Chronic Type B Aortic Dissection

  • Risk stratification to guide medical therapy, endovascular repair (TEVAR), or open surgery.
  • Identification of high-risk features requiring closer surveillance or intervention.

3. Descending Thoracic and Thoraco-Abdominal Aortic Aneurysms

  • Thresholds for intervention based on aneurysm size, growth rate, symptoms, and patient factors.
  • Comparison of open surgical repair versus endovascular and hybrid approaches.

4. Ruptured Aortic Aneurysms

  • Emergency management strategies.
  • Preference for endovascular repair when anatomically feasible and resources allow

5. Traumatic Thoracic Aortic Injury

  • Strong support for endovascular repair as the first-line treatment in most cases.
  • Timing of repair balanced with management of associated injuries.

The guidelines also include

  • Genetic aortic diseases
  • Aortic mural thrombus and “shaggy aorta”
  • Aortitis and inflammatory aortic disease
  • Mycotic (infected) aneurysms
  • Aortic coarctation
  • Aberrant subclavian artery pathology

Key practical recommendations include:

  • Imaging strategies and pre-operative planning
  • Center and operator experience requirements
  • Patient risk assessment and optimization
  • Prevention of major complications, particularly:
    • Spinal cord ischemia
    • Stroke
  • Left subclavian artery revascularization
  • Special considerations for pregnancy
  • Incorporation of the patient’s perspective into decision-making

The ESVS 2026 Guidelines provide a comprehensive and up-to-date framework for managing complex diseases of the descending thoracic and thoraco-abdominal aorta. By integrating current evidence with expert consensus, the guidelines aim to standardize care, improve clinical outcomes, and support individualized treatment decisions across diverse clinical settings.