Endovascular Repair of Thoracic Aortic Atresia in Adults: A Narrative Review of a Rare Entity and Emerging Technique.

Thoracic aortic atresia in adults represents a rare and extreme manifestation of aortic coarctation, marked by complete luminal occlusion and frequently compensated by extensive collateral circulation. This narrative review critically evaluates existing literature and institutional experience concerning surgical and endovascular repair strategies for aortic atresia, synthesizing evidence from related aortic arch pathologies due to the absence of direct comparative studies. Both treatment modalities-open surgical repair and catheter-based recanalization with stenting-have evolved significantly, presenting distinct advantages and limitations influenced by patient anatomy, age, and comorbidities. While surgical repair remains the standard for neonates, infants, and complex cases due to superior long-term durability and blood pressure control, endovascular procedures using chronic total occlusion technique and covered stents offer less invasive alternatives with rapid recovery, particularly in adults with suitable anatomic characteristics. The review highlights procedural considerations, including technical approaches, stent selection, and potential complications such as restenosis, hypertension, and vascular injury. Individualized, multidisciplinary decision-making remains essential, with shared consensus guiding therapy in the absence of randomized trials. The article identifies critical gaps in knowledge, emphasizing the need for multicenter, long-term studies and technological advances-including hybrid and personalized strategies for optimal management and for improving outcomes in this challenging congenital condition.